Avoid Coding Complications Using Fast-track ED Systems
Published on Wed Nov 01, 2000
Although the CPT codes used in fast-track emergency department (ED) services are the same as always, the system of separate treatment tracks does raise some perplexing coding questions.
Not every ED uses a fast-track system, but they have become popular because they can lessen patient complaints, according to Jack Turner, MD, PHD, medical director for documentation and coding compliance, healthcare financial services at TeamHealth, an ED staffing firm in Knoxville, Tenn.
A fast-track system simply shunts some patients to a section of the ED designed for fast treatment, says Jim Pyron, DO, co-director of the emergency department at Freeman Hospital in Joplin, Mo. Its a section of the ED where people are triaged out of the normal ED and into an area where they take care of less-severe problems like coughs, colds or poison ivy. Normally things that are self-identifiable take fewer resources. It cuts wait time.
Although the treatment order may change, the treatment itself is the same, and coders can use the traditional codes. Evaluation and management (E/M) codes, however, can be affected depending on the policy at the hospital. In addition, some facilities use physician assistants or nurse practitioners for fast-track treatment, and coders must know who is providing the service to ensure correct coding.
Fast-track Creates Some Coding Confusion
The biggest coding question surrounding fast-track service involves visit codes. Traditional ED coding requires the use of 99281-99285 (emergency department visit for the evaluation and management of a patient) to reflect the five levels of service. Because of the nature of fast-track services, patients who go through this treatment track are unlikely to warrant more than a level-three visit code. But some facilities have started using outpatient office CPT 99201 - 99203 (office or other outpatient visit for the evaluation and management of a new patient) in place of the ED codes, Turner says.
For the first three levels of service, outpatient office codes pay more than ED codes under Medicare guidelines, with the largest differential at levels one and two.
ED physician groups dont agree with the use of office codes for fast-track services, Turner says, because they dont truly reflect the nature of the visit. Left to their own devices, most physician groups would rather use the ED codes. If we use office-based codes, we water down or diminish the severity of the treatment that goes on in the emergency room. Essentially, youre saying that the problem didnt need to be handled in the ED. As a result, the overall statistics of any given emergency department will show a move toward less-acute problems.
Now there are no official rules prohibiting facilities from billing office codes while physicians bill ED codes. In most cases, facility and [...]
