ED auditing help

VRcoder29

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I am new to ED coding. I have coded for physician services 8 years and now recently got a new job in ED Coding. I need help with understanding some auditing for the ED. Can anyone give me a good resource or something to help me better understand ED auditing? From what I can gather from starting my new job, a lot of these Drs think they should be billing a level 5 but honestly I am not seeing it in their dictation. I just wonder if I am missing something....any help will be appreciated
 

kakaskie

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All the doctors in the ED think it is level 5, you need to score it out with the E/M scoring sheet, if it is Trauma of course use the trama E/M codes. Stand your ground, you are NOT missing anything. Remember if it is not documented it wasn't done. I did ED coding for a number of years along with Trauma coding, HCP's need to learn what determines the level, this is something the ED doc's along with other HCP's need to learn along with proper terminology of the dx codes, especially with ICD-10 coming up.
 

jimbo1231

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Agreed.

ED auditing can be tricky. I agree with Kakaskie about ED docs often thinking everything they do is a 4 or 5. They get that propaganda at their industry meetings. But in fairness to them, they are dealing with new one and done patients that they must work up and pretty much do new patient MDM on every time. A good audit tool helps. The CEDC course is good for background. I have a presentation I did about ED leveling at last years Healthcon. Send me your E and I'll send it to you if you like.
Medical necessity has to be factored into ED level of service coding. But that can be nebulous. Is a sore throat a 4 since there is a Detailed H&P and mod MDM since a med is prescribed? Usually I don't think so, but many do_Or are sprains always a 99282 despite X-Ray interp since without meds . no moderate MDM. Some think so , most don't. And some go all the way to 4 with an X-Ray and med!
So you are kind of auditing a moving target depending on how aggressive your ED is. But I agree a good audit tool and information you will get in CEDC course, and some common sense about ED Levels can help .I've always liked starting from the Presenting Problem and working through the MDM since pretty much all post EMR ED H&Ps are at minimum Detailed these days. And although PP is not officially a factor in ED coding/auditing (It Should BE!!!), it does rule out level 4 sore throats usually.



Jim S.
 
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jimbo1231
Is it possible for me to receive your presentation you did about ED leveling at last years Healthcon. If you have any resources for your presentation would love to see them also. Never posted before and not sure how I get my email to you.

Thanks Lisa
 

jimbo1231

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Wish I Could Find It

I have been looking for that presentation myself! My last computer crashed and I lost it. I've sent it to a bunch of people so I should find it as an attachment. Also it might just be out there in the Cloud if you
Google "A Common Sense Approach to Emergency Department Levels of Service" by Jim Strafford. If you find it, let me know. I need a copy!.

Jim S.
 

jimbo1231

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In the Cloud

Hey I just Googled myself (that somehow doesn't sound right). The presentation I did "A Common Sense Approach To Coding ED Levels of Service" is out there in PDF format.
Just Google Jim Strafford
 
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