ED Coding and Reimbursement Alert

Take note of these tips from Edelberg to see if you are capturing these common ED interventions
Revisit the content of your ED nursing levels. The higher acuity levels (99284 and 99285) reflect the highest and best resources you provide. If they aren't documented and utilized appropriately by nursing, coding and billing staff, you may be allowing too much revenue to slip away. Have nurses and coding staff take another look at the services that each level supports. Here are some questions to ask to help get you to the right code:

• Patient scanned? CT scans, Ultrasounds, Doppler, VQ Scans all indicate a higher level of acuity for patients whose chief complaint requires a higher level of ED resources. Patients who require these services often qualify for 99284 level of service or higher.

• Patients getting IV infusions? Although these services are billed separately, they indicate higher acuity and higher resources for the ED. These patients often qualify for a 99284 level of service or higher.

• Patient intubated? That's critical care. Did doctors and nurses remember to document time spent with the patient? Critical care for the facility requires documentation of the time.

• If patient treatment requires that a consultant come to the ED to treat a fracture or dislocation the resources necessary to support the service of outside consultants and all that go with it generally qualify for a 99284.

• Patient going to observation? Observation can be billed ONLY if the ED service is a 99284, 99285 or Critical Care. Be sure to identify all services to support the patient visit that transitions to observation. Under coding the ED level may result in lost revenue with some payors, for the observation visit as well.

• Patients who present with psychiatric problems, particularly homicidal or suicidal ideations, require nursing observation and additional assessments to support patient care and assist family with finding the right solution. Don't undervalue your services. Although these patients may not require many of the traditional interventions (i.e., meds, diagnostic tests, or surgical procedures) the time and resources required by ED staff can be significant. Be sure mental health evaluations and nursing support of the patient and family throughout the ED visit are identified correctly.