CommercialBilling CodesHigh impact
Acute Stroke and Sepsis Coding in Outpatient Setting
EmblemHealth·Emergency Medicine, Internal Medicine, Family Medicine +3 more·Coding
Effective date
Dec 6, 2024
We identified it
Jun 20, 2026
Summary
Starting December 6, 2024, EmblemHealth will deny all claims for acute stroke (I63.-) or sepsis (A41.-) diagnoses when billed with outpatient place of service codes. These conditions must be billed with inpatient or emergency department place of service codes only.
Action Required
Immediately: Billing team must update system edits to prevent billing acute stroke (I63.-) or sepsis (A41.-) diagnoses with outpatient place of service codes. Train staff to use only inpatient or emergency department POS codes for these conditions. Review and correct any pending claims before December 6, 2024. Claims submitted with incorrect POS codes will be denied.