Question on ED Facility Level Guidelines - Need Clarifiication - LEVEL 4 or 5

Pvdcoder

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Working for multiple facilities, every one has their own guide on the facility leveling. A question brought up on whether to charge a level 4 or 5. According to the Level 4 intervention guidelines, preparation for 2 diagnostic tests which would include EKG, LABS or XRAY. Special Imaging such as CT, MRI, Ultrasound, or VQ Scan. Level 5 states preparation for >3 diagnostic tests and special imaging including contrast or parental medication.

Some coders view this as if a patient came in had lab work, EKG and Chest X-Ray, full physical exam and ROS, no HX, no meds given or prescribed, would give this patient a level 5 because of the 3 tests whereas others say it should only be a 4.

Is high tech radiology - MRI, CT, VQ, U/S not required to even get a level 4 to begin with?

Any help you can offer would be appreciated even just general E&M guidance and examples. Thank you!
 

jimbo1231

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Acep

Did you take a look at the ACEP guidelines? They are pretty specific in terms of what diagnostics etc go with 99284 vs. 5. I think an X-Ray/EKG/labs alone would be pushing it to code 99285 unless some interventions were happening. But as you mentioned it is still kind of the wild west with ER facility coding. Jim
 

mitchellde

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for facility billing each facility is responsible for develpoing their own guidelines for each visit level. They do not need to match any other facility's or any other printed guidelines. you do not use the physician guidelines for facility level determiniation. We used a point system.
 
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Very late answer, but I hope this helps someone looking for similar advice.

I think this visit would be billed as a level 4. If the patient had the same exact workup except that contrast was given then the visit would be a level 5. Anything with contrast automatically goes to a Level 5. The contrast makes all the difference!
 
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