ED Coding and Reimbursement Alert

Consider the difference in payment for a level 5 ED E/M code 99285 (Emergency department visit for the evaluation and management of a patient…) 2017 WRVU: 3.80 and a 2017 payment of $175.85 with that of critical care 99291 (2017 WRVU: 4.50 and a 2017 payment of $226.46).

If you failed to accurately report a legitimate critical care service because of inadequate time documentation or failure to recognize a patent as critically ill or injured that is about $50 lost revenue.

The 2015 Medicare national frequency distribution of ED services looks like this:

If you are coding for an ED with an annual volume of 60,000 patients per year and your ED percentage of critical care goes from 5 to 7 percent, your revenue would increase by $60,000 annually. But of course, your coding choices must be compliant and defensible, Parker warns.