You Be the Expert: Map Identically

Question: I hear conflicting stories about ED facility codes and ED physician codes having to map identically. Can you shed some light on this subject?

Rhonda Hickey, RN, CPC
Compliance Auditor
Baptist Health Corporate Compliance

Test your knowledge. Determine what you would do in this situation before looking at the box below for the answer.



Answer: In most cases the level of care is more intensive for facility rather than physician resources, and physician attendance and treatment are usually reflected in the facilitys expenditure. The Federal Register indicates that there now is no expectation that facility and physician codes match. The requirement is that you develop your own criteria for outpatient care and specialty clinic visits, keep them on file, and use them consistently.

ED facility codes and ED physician codes do not have to be identical, just consistent. For example, based on the documentation, a physician might code an evaluation and management (E/M) level two (99282) for the professional fee. However, the facility, taking into account the nurses documentation, codes a higher E/M level (99283) for the facility fee. This difference is perfectly acceptable for reporting.

- Published on 2001-03-01