ED Coding and Reimbursement Alert

5 levels of NOPP don't always line up with ED E/M. If you don't have a firm grasp on nature of presenting problems (NOPP) levels, you won't be able to choose the most accurate ED E/M code possible for each claim. Why? It's the lynchpin in deciding medical necessity for an E/M service; without accurate NOPP level, you cannot decide on medical necessity for the encounter. "Medicare and insurers will only reimburse for care that is 'medically necessary.' CPT defines medical necessity by the nature of the presenting problem," explains Mary Falbo, MBA, CPC, president of Millennium Healthcare Consulting Inc. in Lansdale, Pa. Get to Know 5 Levels of NOPP The CPT manual defines NOPP as a "contributing" E/M component, but not one of the key elements. Discerning NOPP level is important, however, when choosing the level of medical decision making, explains Yvonne P. Bouvier, CPC, CEDC, senior coding analyst [...]