ED Coding and Reimbursement Alert

Use this method to earn inpatient pay for inpatient services

Just because all inpatient beds are full doesn't mean you can send home from the ED an 84-year-old woman with sepsis. When the hospital is full, the ED picks up the overflow--and the work involved. Don't let your practice's payment reflect an ED visit alone if you are entitled to additional reimbursement. Prepare for the Trend Hospitals nationwide are feeling the crunch of budget cuts and rising expenses, and it shows in the emergency department. According to the American Hospital Association, the number of inpatient beds decreased by 39 percent in the past 20 years. And the national nursing shortage doesn't help matters--hospitals having financial difficulties are increasingly staffing their inpatient beds with the minimum number of required nurses.

This lack of workers leaves facilities and nurses unprepared to care for unscheduled patients, such as ED admissions, says Elijah Berg, MD, FACEP, chief operating officer of Medical Reimbursement Systems Inc., an ED billing company in Stoneham, Mass.

A new class of patients: An -ED boarder- is a patient who is admitted to the hospital as an inpatient but who stays in the ED for an extended period because there are either no beds at all or no adequately staffed inpatient beds available to care for that patient. The patient is essentially in a limbo state, admitted and technically the responsibility of the admitting inpatient physician, but still in the ED.

The culprit: -The primary cause of ED boarding is an inadequate inpatient capacity for an ED population that has increasing levels of acuity and complexity,- Berg says. Not only is bed space more limited, but patients are sicker. Don't Dismiss the Work Most of the time with these patients, the ED physicians end up providing a great chunk of the care, and need to bill for it. -Even if the hospital has formally transferred the patient's care to an inpatient attending physician, the ED attending physician provides some degree of ongoing care and medical legal liability due to the immediate physical proximity of the patient,- Berg says.
 
Some of these patients remain in the ED for the duration of their admission and never make it to an inpatient bed. The length of stay means your physician may be providing all kinds of services, such as reviewing normal repeat lab tests, giving new medications, and even evaluating new complaints (such as chest pain that's entirely unrelated to the original admission). May the Best Code Set Win Often, you-ll have already coded an evaluation and management service (for admitted patients, frequently 99285, Emergency department visit for the evaluation and management of a patient, which requires these three key components within the constraints imposed by the urgency [...]