Emergency Department (ED) coding can be complex, especially in the fast-paced environment of urgent care. For Emergency Department Providers, including facilities and physicians, understanding the coding guidelines is crucial to ensure accurate billing and compliance. This guide serves as your essential “coding crutch training,” offering insights into mastering ED medical billing.
Emergency Department Evaluation and Management (E/M) codes, specifically CPT codes 99281 through 99285, are used to report services provided in the ED. These codes are billed per day and don’t differentiate between new or established patients. A key aspect of selecting the correct ED E/M code is the level of Medical Decision Making (MDM). Accurate documentation of MDM is not just good practice; it’s your foundational “coding crutch” for proper level of service selection. Remember, time is not a determining factor for ED E/M service levels, as ED services are delivered with variable intensity, often across numerous patient encounters.
For claim submissions, it’s important to note specific details. On the CMS-1500 claim form, the Place of Service (POS) code for ED visits is 23. For the UB04 claim form used by facilities, the Revenue Code 0450 is designated for Emergency Room – General services.
The level of service you bill must align with the interventions performed relative to the patient’s presenting symptoms and the resulting diagnosis. Professional coding focuses on the complexity and cognitive work involved, while facility coding reflects the resources utilized by the facility. Medical records and thorough documentation are vital. They serve as a critical “coding crutch,” substantiating the billed ED E/M codes when requested for audits or appeals. Ensure your documentation clearly supports the services rendered to avoid denials and streamline the reimbursement process. By mastering these guidelines, you establish a robust “coding crutch training” foundation for urgent care ED billing.
