ED Coding and Reimbursement Alert

CMS knocks down conversion factor, props up RVUs for ED E/Ms Medicare recently firmed up its 2007 Physician fee schedule, and the final product holds very good news for ED practices.

While nearly every other specialty is expecting a leaner bottom line next year, emergency medicine should actually see more overall reimbursement in 2007. This anticipated increase has a lot to do with the new work relative value units (RVUs) for all ED evaluation and management (E/M) services.

-The RVUs for typical emergency medicine services are changing significantly beginning January 1, with across the board increases for all levels of ED E/M,- explains David McKenzie, CAE, director of reimbursement with the American College of Emergency Physicians. In addition, emergency physicians will also see increased work RVUs for critical care services.

However, the gains won on the ED E/M code RVUs will be offset by CMS- decrease of the conversion factor (the rate Medicare pays per RVU), McKenzie explains. Here's a look at what the new Physician fee schedule holds for your ED: Level 2 E/M Worth 60 Percent More This Year While some ED codes got higher increases than others, each level of E/M got an RVU bump in the new fee schedule. Here is a list of the E/M codes and their new RVUs assignments:

- 99281 -- Emergency department visit for the evaluation and management of a patient, which requires these three key components: a problem focused history; a problem focused examination; and straightforward medical decision making 
2006 RVUs: 0.33 2007 RVUs: 0.45

- 99282 -- an expanded problem focused history; an expanded problem focused examination; and medical decision making of low complexity
2006 RVUs: 0.55 2007 RVUs: 0.88

- 99283 -- an expanded problem focused history; an expanded problem focused examination; and medical decision making of moderate complexity 
2006 RVUs: 1.24 2007 RVUs: 1.34

- 99284  -- a detailed history; a detailed examination; and medical decision making of moderate complexity 
2006 RVUs: 1.95 2007 RVUs: 2.56

- 99285 -- a comprehensive history; a comprehensive examination; and medical decision making of high complexity 
2006 RVUs: 3.06 2007 RVUs: 3.80 So why did CMS up all of these RVUs at once? According to Eli Berg MD, FACEP, chief operating officer of Medical Reimbursement Systems Inc., an ED billing company in Woburn, Mass., and Chair of National ACEP's Reimbursement Committee, it is not unusual to see RVUs spike for all five E/Ms in the same year.

-CMS recognized the increased work associated with all the ED E/M services,- which led to the RVU improvements, Berg explains.

Best bet: You need to be absolutely sure that your E/M claims are coded to the proper level. Remember, nearly all ED patients receive some type of E/M, explains McKenzie, who says between 80 and 85 percent of total revenue for most EDs comes from E/M services. If you-re undercoding (or overcoding [...]