Reader Question: Matching Levels in the ED

Question: In the past I heard a lot of information pertaining to APCs that said the physician level and the facility level need to match for ED services. Then I heard that they did not need to match. Which is true?

Illinois Subscriber

Answer: The good news about ED services is that the physician and facility levels do not need to match. Going into APCs, there was a lot of discussion at the HCFA level, and a lot of publications and updates said they would have to match, but HCFA has stated in the final regulation that they are not expected to match.

So your emergency physician level could be lower than your facility level, if you consider that other physicians may come into the ED and carry on the treatment of that patient and, subsequently, admit that patient and provide treatment. Now we know that your outpatient services on the facility side will get bundled into your inpatient charges, but for tracking you may want to find a way to keep those levels separate.

HCFA does expect you to have some type of tiered structure for assigning your facility levels. They will be identified with the evaluation and management codes. Whatever you choose, it needs to be realistic and it needs to be tiered. You dont want to put everything into your highest-level APC. Youre looking at generally three to five levels.


- Published on 2001-01-01