ED Coding and Reimbursement Alert

Double-dipping is not just a social faux pas; it can get your practice into compliance trouble. But don't be duped by your own fear. In certain circumstances, you can use the same E/M documentation statement twice.

Double-dipping for E/M claims is a no-no when you count the same documentation statement as two different elements within one E/M component, says Todd Thomas, CPC, CCS-P, president of Thomas & Associates, a company ensuring reimbursement for emergency physicians in Oklahoma City. The history components are the history of present illness (HPI); review of systems (ROS); and the past, family and social history (PFSH).                                                      

So, if the patient says, "My problem started yesterday," you can't consider that single statement as the timing element and the duration element in the HPI.       

 Or if the documentation states, "Patient has no chest pains," you cannot count that element for the cardiovascular and musculoskeletal elements in the ROS, Thomas explains.                                                                                         

You can count the same statement, however, for two different elements in different components, say, the HPI and ROS, Thomas says. And this is what coders may not know or are afraid to follow. You can use thestatement "Patient has no chest pains" for the cardiovascular element in the ROS and an associated sign and symptom in the HPI.                                                                                        

 "I have reviewed many charts over the years that could have been and should have been coded at a higher [E/M] level," Thomas says. And he credits the downcoding to the coder who works "under the myth of a double-dipping issue."