# ER coder looking to advance



## sbtomberlin (Jan 11, 2009)

I was just certified as a CPC-A last September with no previous medical experience...I just took a class. I volunteered in medical records at a local hospital for a week before I was officially hired on. Since then I have been coding ER charts for about 3 months. I just have some general question about how ERs are coded in other hospitals because it seems that we do it very differently here. I want to move and work in a bigger city within the next year so I'm just trying to learn as much as I can and prepare myself. 

At the hospital I work for we use Meditech for all of our coding. I don't handle any of the billing. I just go through each day's charts and code all of the diagnoses (including the underlying symptoms...I know some places don't do this but they made it a policy here due to rejections). I only use certain procedure codes, like for splints, casts, fracture reductions, sutures, catheters, etc. I don't use any E/M codes...which, looking through here, it seems like everyone else does. 

Keep in mind that I live in a very rural area and other than the program we use which looks up the codes for us, it seems like we're 10-15 years behind everyone else. We still use paper charts and have to physically file them ourselves. What else would I need to learn to prepare myself to work in ER coding at a bigger hospital? How different is what I do compared to where you work? Thanks!


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## Anna Weaver (Jan 11, 2009)

*ER coding*



sbtomberlin said:


> I was just certified as a CPC-A last September with no previous medical experience...I just took a class. I volunteered in medical records at a local hospital for a week before I was officially hired on. Since then I have been coding ER charts for about 3 months. I just have some general question about how ERs are coded in other hospitals because it seems that we do it very differently here. I want to move and work in a bigger city within the next year so I'm just trying to learn as much as I can and prepare myself.
> 
> At the hospital I work for we use Meditech for all of our coding. I don't handle any of the billing. I just go through each day's charts and code all of the diagnoses (including the underlying symptoms...I know some places don't do this but they made it a policy here due to rejections). I only use certain procedure codes, like for splints, casts, fracture reductions, sutures, catheters, etc. I don't use any E/M codes...which, looking through here, it seems like everyone else does.
> 
> Keep in mind that I live in a very rural area and other than the program we use which looks up the codes for us, it seems like we're 10-15 years behind everyone else. We still use paper charts and have to physically file them ourselves. What else would I need to learn to prepare myself to work in ER coding at a bigger hospital? How different is what I do compared to where you work? Thanks!



I also code ER's but I only do them on the side, when needed. It sounds like your hospital is much like the one I work for. We also use Meditech and 3M software for coding. We don't have to do the E/M visits as they are hard coded into the charge master and when they do the documentation in the ER this is taken care of. The injections and such are also hard coded. The only CPT's we have to do are for immunizations, splints, etc. Sounds much like what you are doing. We also are working from paper, not from an EMR. We also code from all the documentation in the chart that is signed by the physician (not from nurses notes). They have templates they use, the Dr. signs and anything documented there is fair game for us. 

I just wanted you to know you are not alone, and unfortunately, I can't help you with your quest to upgrade your job so to speak.


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## dauley (Jan 13, 2009)

Our ER charts are mostly paper still, although the facility is rapidly moving to EMRs across the board.  Our doctors decide their own EM levels by choice but our HIM dept. figures the facilty side.  We are a CAH so we don't use DRG when coding, but we keep it in mind incase our status changes down the road or if we as coders leave.  Many of our CPTs are harded coded as well, I prefer this as it makes my job easier. (well usually)  I don't deal with the insurances/billing but I am held accountable for the medical necessity of what I release and the codes I attach.  My coding is audited by an outside source periodically and I'm held to a 95% accuracy rate.  I code ERs, In patients, Short Stays and Surgeries, but the ERs are my favorite. The coding of symptoms along with the cause seems like a bad idea...the AAPC classes I've gone to call it 'over coding'.  Coding rules tell you NOT to code the symptom if the underlying cause is identified.  If you're not using DRG to code try to find out as much as you can about it.  Knowing how to get EM levels will come in handy for you too.  I've attended classes for both (even though I don't use it in my current setting) and the information is fairly easy to comprehend and apply.  I'm happy in my small town atmosphere but I wish you well and good fortune in your career and advances.


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## cburch (Jan 15, 2009)

*ED coding*

I code for the ED for our small rural hospital and pretty much have the same circumstances. I do figure the E&M level for the docs but not for the facility. The facility level chg is determined by nursing staff and I don't feel that they consistently follow any certain criteria. I am curious what guidelines you use for determining facility level chg.
Cheryl, CPC


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## ptrautner (Jan 24, 2009)

we do both we do diagnosis coding and e/m on both professional and facility, we code out all nursing i.e. iv's meds supplies etc.  

it is worth learning, and something many coding consulting firms look for as well as hospitals.  We use asep guidelines which are pretty easy to follow. 

i think coders should be determining the levels, since neither nursing nor docs are experienced enough to determine always.  We have docs that think they earned a higher level than they actually did, some are more well versed in the coding realm than others i will admit. still that is my opinion that we should be responsible for the e/m assignment and not them.


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## ptrautner (Jan 24, 2009)

*acep guidelines link:*

http://www.acep.org/practres.aspx?id=30428


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## elliotp (Feb 4, 2009)

I code in a Critical Acess hospital in a small town.   We assign E&M levels for the Dr's and assign codes.  I was taught that if a pt. is seen more than once on the same day to only charge for one E&M level.  Recently,  I was told to charge an E&M level for each visit.  I can not find any documentation to support this.  Can someone direct me ?  or tell me what they do about multiple visits on the same day ?   I have been coding in the hospital setting for 2 yrs.  previously coded in the clinics for 8 yrs.  Thanks !  

Pat E., cpc


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## ptrautner (Feb 5, 2009)

It is all over, i have a friend who works at another hospital and he does all paper charts, many of our hospitals have the EMR.  So it just varies/


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## Anna Weaver (Feb 9, 2009)

*multiple e/m*



elliotp said:


> I code in a Critical Acess hospital in a small town.   We assign E&M levels for the Dr's and assign codes.  I was taught that if a pt. is seen more than once on the same day to only charge for one E&M level.  Recently,  I was told to charge an E&M level for each visit.  I can not find any documentation to support this.  Can someone direct me ?  or tell me what they do about multiple visits on the same day ?   I have been coding in the hospital setting for 2 yrs.  previously coded in the clinics for 8 yrs.  Thanks !
> 
> Pat E., cpc



Pat, 
Sorry, I can't direct you, but now I will start researching also. We do not bill multiple E/M's on the same day, we code from all of them, but charge only one E/M. Since ours are all hard coded, I can't tell you whether they combine or just go by documentation on either of the visits. (My assumption is combined since we code from both.)


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