Wiki E/R E/M Levels

[dballard2004]

All,

When it comes to assigning E/M levels in the ER, do we use the 95 or 97 guidelines, or am I correct that the facility determines the documentation requirements for each level? I am new to ER auditing and I thought I had read somewhere once that the facility decides the documentation requirements. If so, where can I find this guidance?

 

[thomas7331]

All,

When it comes to assigning E/M levels in the ER, do we use the 95 or 97 guidelines, or am I correct that the facility determines the documentation requirements for each level? I am new to ER auditing and I thought I had read somewhere once that the facility decides the documentation requirements. If so, where can I find this guidance?

If you are coding the physician's professional claim for an ER service, you would use the CPT definitions and follow the 1995 and/or 1997 guidelines, just the same as you would for any other E&M services.

If you are coding the facility's claim, to be billed on a UB-04, then you would determine the level based on the facility's guidelines for how the level is to be calculated. Facility claims are not based on the same criteria (i.e. history, exam and MDM) as physician claims because facility's bill based on resources used during the encounter, not on the complexity of the physician's work.

 

[dballard2004]

Thanks so much!