# elements for e/m level



## ness01 (Feb 25, 2009)

My employer says we dont need to count the elements for each section of an ER chart because it is an emergency setting so the Drs are not required to complete all that decumentation. This is that 1st time Ive heard this. I know if the situation is emergent and they cannot finish the exam due to pts critical sts then they can use a caviaut. Otherwise why would they outline the requirments in the cpt book if it is not necessary. Let me know what you think.


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## Lisa Bledsoe (Feb 26, 2009)

You *must* count the elements.  That is the only way to determine the level of service.  Yes the caveat is there but only for critical situations and documentation must support its use.  Your employer is dead wrong on this.  CPT guidelines must be followed.


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## kevbshields (Feb 26, 2009)

I concur with Lisa.  CPT makes no such allowance--hence the requirement for all three (3) key components being required on ER/ED services.  All you'd need is a current year CPT manual and the ER/ED subsection notes to prove that point.


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## dmaec (Feb 26, 2009)

you're talking profee charges only right?  
"ED  - Facility Level Coding Guidelines At this point, there is no national standard for hospital assignment of E&M code levels for outpatient services in clinics and the Emergency Department (ED). CMS has stated that each hospital may utilize its own unique system for assignment of E&M levels."
often, the profee side level may differ from the facility side (imagine that)! (that always bothers me - but it's true).  this website gives a few examples - http://www.acep.org/practres.aspx?id=30428
I can't find my other info on this (yet) 

oh - and the E/M score sheets for the ER/facility are quite different than the physician pro E/M score sheets.


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## Lisa Bledsoe (Feb 26, 2009)

Donna - the article you posted/quoted is for the facility setting as far as I can tell.  Physician coding must follow CPT guidelines.


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## dmaec (Feb 26, 2009)

Lisa - *nods*yup...... that's why I was asking,...pro/fac side - which one is her employer referring to?... yes, physican side we have to follow CPT  - however, as I stated, facility side is different... maybe that's what her employer was referring to??..


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## Lisa Bledsoe (Feb 26, 2009)

Gotcha.  I inferred that she is talking about physician coding because she mentions that she was told the doctors don't have to complete "all that documentation".


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## dmaec (Feb 26, 2009)

Lisa -  you're most likely correct on that too!  (I sort of read over that part!) LOL.
that being said then - you and Kev nailed the answer


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## ness01 (Feb 26, 2009)

yes I can coding the professional services. Thanks for your feedback.


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