ED Coding and Reimbursement Alert

Question: If a patient is seen by two different docs in ED, one starts treatment then hands over to another doc, which doc should be used as attending? I have two different opinions in my company. Some use the doc who signed off or completed the chart and others use the doc who did the most work based on the chart documentation. Which is the better policy?

Michigan Subscriber

Answer: There is no CMS or CPT® policy on the issue. The majority of ED groups attribute the work to the provider that completes the chart and determines the final disposition. Those groups that incentivize providers based on RVU production want to be sure the payment goes to the one who completes the encounter to avoid dumping patients on another provider who does not get credit for the work.

Certainly many patients will need to be handed off at change of shift, and in those cases a reasonable policy on allocating the work to the provider who completed the majority of the visit should get would seem reasonable.

For example a patient that required significant workup and reassessment but is just waiting for final labs before discharge at shift change would suggest the fair allocation would go the provider that spent hours with the patient. An exception would be observation discharge, in which case the physician writing the discharge summary should receive credit for that code encounter.

As with all incentive plans, you should reward the behavior you want to improvement. Crediting the patient to the provider that starts the case rewards quick door to physician times. Crediting the discharging provider encourages timely disposition. You should address this question with the decision makers in each group and set a consistent internal policy.