Emergency Department – Facility Coding

There are no national guidelines for E/M leveling exist, so all the facilities have a tweak on their guidelines.

At Medcodia, our coders have minimum of 5 year of ED Facility coding experience with experience of multiple EMR software including Epic, NextGen, Cerner Power Chart, eClinical Works, CPSI as well as Sorain.

The 11 guiding principles CMS published in its 2008 OPPS final rule indicate that the coding guidelines should have

1. Follow the intent of the CPT code descriptor in that they should be designed to reasonably relate the intensity of hospital resources to the different levels of effort the code represents.
2. Be based on hospital facility resources. They should not be based on physician resources.
3. Be clear to facilitate accurate payments and be usable for compliance purposes and audits. To determine whether your guidelines are clear and usable, ask someone who uses them to explain the tool.
4. Meet HIPAA requirements.
5. Require only documentation that is clinically necessary for patient care.
6. Not facilitate upcoding or gaming.
7. Be written or recorded, well documented, and provide the basis for selection of a specific code.
8. Be applied consistently across patients in the clinic or ED to which they apply.
9. Be flexible.
10. Be readily available for FI or, if applicable, MAC review.
11. Result in coding decisions that could be verified by other hospital staff members, as well as outside sources.

At Medcodia, we would be happy to take on any backlog to make sure your Emergency Facility Billing and Coding are current.