ED Coding and Reimbursement Alert

Rules for reporting these encounters differ from rules for other E/M services
 
When the ED physician provides subsequent hospital care to a patient, the onus is on the coder to choose the proper level of evaluation and management service based on the physician's notes -- and this can be a very challenging undertaking.
 
ED coders often under-report subsequent hospital care services, resulting in a lower payout and hurting the facility's overall finances. This could occur if a coder fails to realize that she need not satisfy all of the E/M components to report the subsequent care codes, says Catherine Brink, CMM, CPC, president of Healthcare Resource Management of Spring Lake, N.J.
 
Another issue: As if under-reporting weren't enough of a potential problem in subsequent hospital care coding, the coder could also over-report subsequent care service if she does not include documentation to back up her code choice, which could lead to denials and suspicious payers.
 
There are some tricky aspects to subsequent hospital care coding, but if you pay attention to the special rules and observe the documentation guidelines, you can ethically max out your revenue for these services.
 
2 out of 3 Ain't Bad for These E/M Codes Your ED physician may provide subsequent hospital care to patients for several reasons, including contractual obligations, after-hours resource limitations, or general clinical responsiveness.
 
For example: The ED physician is needed to assess a floor patient who is having shortness of breath or chest pain. Frequently these -floor responses- will not meet the full requirements for reporting either a critical care code or a consult code. Choose From 3 E/M Levels for Subsequent Care When you are choosing a service level for these encounters, you-ll decide among these codes:

- 99231 -- Subsequent hospital care, per day, for the evaluation and management of a patient, which   requires at least two of these three key components:   a problem-focused interval history; a problem-   focused examination; medical decision-making that   is straightforward or of low complexity

- 99232 -- ... an expanded problem-focused interval  history; an expanded problem-focused examination;  medical decision-making of moderate complexity

- 99233 -- ... a detailed interval history; a detailed   examination; and medical decision-making of high   complexity. But be careful when selecting a code from this family, because 99231-99233 claims have different reporting rules than the standard ED E/M services.
 
For most ED E/M services, such as 99281-99285 (Emergency department visit for the evaluation and management of a patient ...), you must meet all three key components in their E/M description -- history, physical exam, and medical decision-making (MDM). To claim 99231-99233, however, the physician only has to meet two of the three key E/M components, says Mary Falbo, MBA, CPC, president of Millennium Healthcare Consulting Inc. in [...]