COVID-19 ED Recommendations from NES Health – Leader in Emergency Department Management

Update to NES Health COVID-19 Blog:
Monday, April 6th 2020

Over the past few weeks, NES’ Leadership team, along with every NES Site Medical Director, has joined a daily call to provide updates of their emergency departments, and how they are managing the COVID-19  crisis . The purpose of the call is to share rapidly changing best practices, discuss how this crisis is affecting our EDs and our teams of providers, and provide an opportunity to problem solve. Most importantly, the calls provide a support system for all our physician leaders facing the front-line of this pandemic.

Daily news about COVID -19, its expansion, efforts to treat it and medical advances on testing change rapidly.  Our effort in sharing ongoing COVID-19 blog updates with you is to provide updates from our frontline ED Physicians, information we receive from the CDC and WHO and a few stories on how  our amazing SMDs  are finding  unique ways to  fight this battle and keep their  communities safe. We are ALL in this together; Transforming Patient Care, Together.

Updates from IHME:

COVID-19 projections assuming full social distancing through May 2020

Updates from

Additional Background: Sweeping Regulatory Changes to Help U.S. Healthcare System Address COVID-19 Patient Surge

Trump Administration Makes Sweeping Regulatory Changes to Help U.S. Healthcare System Address COVID-19 Patient Surge

INDUSTRY EXPERTS – guest speakers discuss: Telemedicine, Billing & Coding, Technology, Malpractice, etc.

LogixHealthJim Blakeman, EVP and Robert Dietz from, VP of Practice Strategies

  • Patient geographic limitation has been waived – patients can call in from anywhere for telehealth (home, waiting room, tent, car)
  • Healthcare provider that wants to use audio or video communication technology to provide telehealth to patients during the COVID-19 nationwide public health emergency can use any non-public facing remote communication
  • Providers may use popular applications that allow for video chats, including Apple FaceTime, Facebook Messenger video chat, Google Hangouts video, Zoom, or Skype
  • NES can provide a ZOOM account – please contact your RVP if you would like a ZOOM account

Full Detail Bulletin from Logix Health for EM Physicians

LogixHealth is the recognized leader in emergency department revenue cycle services. LogixHealth provides emergency physician encounter coding and all related billing services for a variety of practice types nationwide, including premiere large academic teaching hospitals, large multi-site groups, smaller fee-for-service groups and hospital employed physicians.

Probill – Sandi Adkins, VP of Revenue Cycle Management

The ICD 10 codes for COVID- 19 are:  

  • 818- encounter for observation for suspected exposure to other biological agents ruled out.
  • 828- contact with and (suspected) exposure to other viral communicable diseases
  • 1 – COVID-19 virus identified.
  • The Z codes will be used for patients that have suspected or confirmed contact with someone who is confirmed COVID-19 positive.
  • The U code will be used for confirmed cases of COVID-19 patients.
  • These codes will be important for quickly identifying COVID related patients and possibly qualifying for additional reimbursement

Westwood Insurance – Michael Richards, Director/Insurance Broker

  • Liability issues will consider the conditions and state of emergency providers are working under
  • States are driving the changes and relaxing restriction on providers practicing across state lines
  • Insurance companies are implementing questionnaires related to COVID 19 exposure- COVID 19 practices and the renewing of policies
  • COVID-19 and HIPAA: Disclosures to law enforcement, paramedics, other first responders and public health authorities

Information about HIPAA Privacy and COVID-19

Disclosures of PHI to law enforcement officials is available in OCR’s HIPAA Guide for Law Enforcement

Uses and disclosures of PHI for public health

NES Site Medical Directors around the country – Leading their ED and community to safe care during COVID-19:

VIDEO: Dr. Steve Wexler, Chief Medical Officer with NES Health & ED Chairman at Day Kimball Hospital in Putnam, Connecticut

VIDEO: Dr. John D’Angelo, Site & Regional Medical Director at Trinitas Regional Medical Center in Elizabeth, New Jersey

VIDEO: Dr. Jonathan Woolery, Site Medical Director at Sierra View Medical Center in Porterville, California

Live Chat Weekly: Dr. Chadwick Gaddis, Site Medical Director at Howard Memorial Hospital in Nashville, Arkansas

Monday,March 23rd 2020

Emergency Medicine News Journal: What’s Working for COVID-19 Patients

The number of diagnosed COVID-19 cases in the United States is climbing each day. While hospitals prepare to manage the potential surge of contagious patients, healthcare leaders work diligently to implement changes to guidelines by quickly developing protocols to minimize the exposure to hospital staff and vulnerable patients. NES Health’s physician leadership and front-line clinicians are in rapid-response mode to address preparedness for this global pandemic. With over 35 Emergency Departments under NES management throughout the country, we are focused on education, infection control, supply and resource management, and communication with public health authorities.

Last week, NES leadership initiated daily COVID-19 meetings. These meetings with all physician leadership will provide department updates, share best practices, and answer questions with other NES Health clinicians across the country via conference call. In addition to provider focused meetings, NES Health’s executive and clinical leadership team are meeting with hospital CEO’s on a weekly basis to address challenges, provide updates and answer questions. While each hospital and provider’s circumstances are unique, NES’ recommended best practices are as follows:

NES Health’s current recommendations for COVID-19:

  • When possible, keep patients from entering into the hospital Emergency Department.
  • See patients in alternative treatment locations such as outside tents, on in their cars curbside.

Walk through the outside tent at Day Kimball Hospital in CT with NES Health Chief Medical Officer, Dr. Steven Wexler.

Walk through the outside tent at Trinitas Regional Medical Center in NJ with NES Health Regional Medical Director, Dr. John D’Angelo

  • For hospitals that cannot achieve an outside protocol, patients should be seen in isolated areas away from the general Emergency Department.
  • Patients that are unstable or more clinically ill, should be placed in a negative pressure room.
  • All entry ways to the hospital should be closed.
  • Ensure a strict policy on visitors into the hospital. If you allow visitors, keep to a ONE visitor per patient maximum assuming they are not symptomatic.
  • All patients brought to the ED by EMS should be screened outside of the hospital.
  • Recommended PPE: N95 mask, gloves, blue gown and eye shields/goggles. N95 masks can be reused if removed properly and not soiled. NES recommendation is to wear a surgical mask on top of the N95 mask to keep it from getting soiled. Currently there is a national N95shortage.
  • In the case of having to intubate a patient, a PAPR with positive pressure ventilation should be worn with the blue gown and gloves.
  • Arrive at work with a change of clothing to change into at the end of your shift. Clothing should be immediately bagged and washed separately from other laundry.
  • Shower before leaving the hospital.
  • Remove all facial hair; PAPR’s are limited.
  • Deep nasopharyngeal swabbing up both nares is the recommended approach to testing.
  • Steroids should NOT be used in this patient population.
  • NSAIDS are safe in this patient population. If nebulized treatments are needed, this should be done in a negative pressure room. The use of NIPPV or high flow oxygen should be done in a negative pressure room.
  • It is an expectation that ED Site Medical Directors meet with hospital leadership to coordinate the flow, treatment, and hospital visitation policies. SMDs should provide names and contact information for all community based physicians that could back-fill the ED in the event of a complete staffing crisis.
  • Consider working with state and local agencies to influence the acceptance of healthcare professionals licensed in other states.
  • Ensure emergency credentialing is available, and everyone required to participate in that process is accessible to expedite requests.
  • When not working in the ED or hospital, we advise all clinicians to get as much rest as possible, focus on healthy nutrition, and exercise in order to keep your mind and body healthy.

COVID-19 response and protocols are evolving rapidly and recommendations will most likely change. To remain updated, please refer to CDC guidance for our healthcare professionals.

We are exceptionally proud of our providers who risk their own personal health and the health of their loved ones to care for all patients that present in our Emergency Departments. We are doing our best to keep them safe.

NES Health
Transforming Patient Care, Together.