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Facility ER E/M coding

  1. Default Facility ER E/M coding
    Medical Coding Books
    In trying to explain the difference between facility & physician ER E/M coding to superiors within my organization, I have presented the following:

    •HCPCS/CPT codes = a way to adequately describe level of physician effort (evaluation and management, including history, exam, medical decision making)
    •HCPCS/CPT codes do not = a way to adequately describe non-physician resources (ER room time, ancillary services, nursing, imaging, etc.)
    Therefore, a direct correlation between facility E/M billing & physician E/M billing cannot be made.

    I have pointed out:
    •CMS has NOT issued national guidelines for E/M coding.
    •CMS HAS indicated that hospital must develop a mapping system (65 FR 18451)].
    •Each facility must follow its own system which "reasonably relates the intensity of hospital resources to the different levels of HCPCS codes." CMS has indicated that it "would not expect to see a high degree of correlation between the code reported by the physician and that reported by the facility." (65 FR 18451)

    Am I correct in thinking that without a given facility's ER mapping logic, an "audit" of E/M (facility) would not be accurate? Thanks for any feedback.

  2. #2
    Columbia, MO
    You are correct. Each facility is to create their own system(guidelines) and it must be in the policy and procedures manual and each employee is suppose to know and understand the "system" our hospital used points for different activities such as vital signs, anything that cannot be coded with a CPT ot HCPCS II code can be captured with your system/guidelines.

  3. Default Facility ER E/M coding
    Thanks so much for your help Debra.

  4. Default
    Where do I look for the points for each activity?

  5. #5
    Columbia, MO
    You have to determine this for your individual facility. For instance we decided that taking vital signs was 5 points but continuous vital signs, like every 2 hours, would be 15 points. To take a patient to carry was 5 points, to have the portable X-ray brought to,the ER would be 10 points. And so on. Anything that consumes a resource ( nurse, patient transporter, etc) that is not accounted for in a specific CPT code.

    Debra A. Mitchell, MSPH, CPC-H

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