It is paramount that this proposed legislation be withheld as it has potential to erode the ability of Emergency Departments to provide appropriate, thoughtful, emergent-focused safety net care.  A host of the complaints included on this list have the potential to be life-threatening when they initially present to the ER and as such may require extensive complex workups. Examples include abdominal pain that could be initially concerning for a blockage of the bowel or appendicitis warranting CT scan and bloodwork but if fortunate the patient may be diagnosed with R10.84 'generalized abdominal pain' ($14.98); back pain that requires MRI to rule out emergent spinal conditions such as spinal cord compression or spinal infection but ultimately diagnosed as M54.5 low back pain ($14.98).  E10.10 Diabetic ketoacidosis and J45.52 status asthmaticus are diagnoses used for patients we commonly admit to the intensive care unit that require significant focus and attention of our emergency medicine staff and providers -- not worthy of an E/M level 1 $14.98 charge. The list continues. 

Should this be allowed to pass emergency departments will ultimately have to adjust staffing and resources to remain sustainable, ultimately to the detriment of the communities we serve.  Emergency department care is the safety net and should continue to be supported as a pivotal service -- this legislation would erode our ability to do so.