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ED Coding and Reimbursement Alert

Facility Documentation Guidelines:

Know the Rules for Mapping Professional and Facility Code Levels

Published on Wed Mar 21, 2012

Does your current mapping methodology contain the 11 elements CMS requires?CMS has no official methodology for determining ED facility levels, but if you know where to look, there are some guidelines available for crafting your own. Read on to learn the source of CMS' guidance and tips on how to apply it to your practice.Basics: There are two components to consider when reviewing ED cases for reimbursement; the professional component for physician services and the facility component for other services, including nursing and ancillary services. The CMS Outpatient Prospective Payment System (OPPS) gives hospitals direction for reporting facility services using the CPT® E/M codes. At this time, there are no national guidelines for the assignment of the E/M codes for outpatient facility services in the ED. According to the FY 2012 OPPS final rule, hospitals are to continue to follow the directions published in the FY 2008 OPPS final rule, [...]
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