Actually, I'm going out a limb here. Charging ER codes may be appropriate, if you can substantiate that the level of care required was the determining factor for code assignment. Since you're coding for the facility and CMS has yet to produce any explicit guidance on facility clinic and ER coding, the institution (facility/hospital) holds the right to determine the appropriate E/M level based on everything except physician work.
What this means is that if infusions, injections and similar-intensity nursing services fall to the ER code set, then that is a reproducible method of determining OP code levels and meets the intent of CMS's existing guidance. I'd just ensure that whatever method is employed is done so consistently.
In the meantime, "advertising" clinic hours and charges may not be the best approach with ER services. I'd be reluctant of that, but not much else. One thing that administration and clinicians must understand is that coding and charges are determined not by the time of the encounter, but by the level of care required (medical necessity).
I hope this helps. Check out the previous OPPS guidance for ERs here
I am not a whiz with the CMS website searches, so you may have to refine it.
Last edited by kevbshields; 10-06-2010 at 05:46 PM.
Kevin B. Shields, RHIT, CPCO, CCS, CPC, COC, CCS-P, CPC-P, CPC-I