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ER Facility Levels

  1. #1
    Default ER Facility Levels
    Medical Coding Books
    Is there a reference that defines what each level of ER facility charges are? I'm not talking about E/M ER codes (99281-99285), but the facility level charge. I found this, but I think it's defining levels of Triage:

    In general, the triage system has five levels:
    Level 1 – Immediate: life threatening
    Level 2 – Emergency: could become life threatening
    Level 3 – Urgent: not life threatening
    Level 4 – Semi-urgent: not life threatening
    Level 5 – Non-urgent: needs treatment when time permits.

    Does anyone know the definitions for the facility level charge?

    Thank you so much!

  2. #2
    Columbia, MO
    The facility level is determined bu facility specific criteria. Meaning each facility was given the responsibility to design their own criteria for determining the specific E&M level. The facilities do use the physician levels just with their own criteria. The criteria you have cited is probably triage criteria as it is not specific enough for E&M levels.

    Debra A. Mitchell, MSPH, CPC-H

  3. #3
    Thanks Debra - that makes sense. Do you think it's a safe assumption that many facilities would use Level 1 as lowest - Level 5 as the highest level (similar to the E/M codes)? I ask because the triage info I gave is the opposite.
    Are facilities forthcoming about their definitions of levels, if asked?

    Thanks again!

  4. #4
    Columbia, MO
    For the facility you use the same E&M codes as the physician, 99281-99285 and for clinic 99201-99215
    Our facility used a point system, certain things were given so many points such as vital signs were 5 points, continuous vital signs were 15 points, neuro checks were 5 points, and so forth. It is not physician activity you are capturing it is the utilization of facility resources, so if the patient needed to be escorted to the lab or radiology, we attached 5 to 15 points for the use of the transporter. anything that could not be captured with its own CPT code. Then the points would add up to a level, 5 to 10 points would be the 99281 or 99201/99211 and so on. Every facility is different and even if another facility uses points their points are going to be different. I am not sure how willing they will be to share their facility"tool" but it never hurts to ask.

    Debra A. Mitchell, MSPH, CPC-H

  5. #5
    Thanks again Debra - that is helpful!


  6. #6
    Greater Portland (Maine)
    Try the ACEP website. I believe they still have some facility guidelines to start with.
    RCBartholomew, CPC-H, CEDC

  7. Default Facility Levels
    There should be 2 articles I wrote on facility leveling on the AAPC web site in Coding Edge. It pretty much covers the ground that has been discussed, but might be of some help. There are some software packages out there like Lynx that are pretty good. Based on the data that's out there ED Facility coding is much more all over the place that physician ED coding in terms of acuity percentage for the reasons given which are that it is pretty much up to the facility. A lot of revenue is lost on facility level undercoding, and there is RAC risk on facility overcoding. But I still see more under than over.

    Jim Strafford CEDC MCS-P

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