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ED professional and facility coding and billing guidelines

  1. Question ED professional and facility coding and billing guidelines
    Medical Coding Books
    We are thinking about opening ER.

    This coding subject is new to me. I know that we have to bill both for professional and facility services.

    What specific resources could I use to learn in details regarding coding guidelines for those services?

    I would like to have clarifications on what services are bundled or could be billed in addition to ED EM codes for professional services.

    I would like to have clarifications on what services are bundled or could be billed in addition to ED EM codes for facility services.

    I will appreciate your help.


    Yulia Miler

  2. Default A lot of ground

    The Guidelines for ED Professional and Facility coding cover a lot of ground. Basically for Professional services; most coders follow the CPT and 95 Medicare Guidelines. On the facility side there are no specific guidelines in determining Levels except that the CPT codes are used. There are a number of approaches including point systems, matrixes and the ACEP guidlines. You might look at the ACEP web site for their facility guidelines.
    The basis for coding a procedure in addition to an E&M is that there is a separately identifiable procedure in addition to the E&M as the modifier 25 describes.
    But if you are just getting into this I would reccomend the AAPC practicum for the CEDC certification as an intoduction to ED coding. On the facility side, there are resources on the internet. And you might look at my article in The Coding Edge January edition and one coming up in April.

    Jim S.

  3. Default

    Thank you very much. I have researched both CMS and ACEP websites, as well as re-read your article, and found the answers to most of my questions.

    Are there any additional websites I could gather more information regarding facility billing?



  4. Default Other sources

    If you google Emergency Department Facility coding or Leveling, you should find a few sites. Lynx and McKesson have products for facility ED coding. Haven't used them so I can't comment. But Lynx has a good Leveling coding manual that you can get from the site.. There are also numerous articles about infusion/hydration coding which is a big complonent of ED facility coding.
    I'm would also reccomend having at leat one experienced ED coder on board (depending on volume of visits) if you are jumpling into this without ED experience.
    Good luck.

    Jim S.

    And I have another article on the different methods of ED Leveling (there are quite a few to choose from) coming in the April Ccoding Edge.

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