ED Coding and Reimbursement Alert

Question: We would like to know if we will need to bill for nurses services separately under the new APC guidelines. The hospital currently does not bill fee-for-service, but the doctors do. How do these new regulations affect our procedure coding and encounter form?

Alabama Subscriber

Answer: Ambulatory Payment Classifications (APCs) only apply to the facility component of the patients visit. As such, nursing services are included in the APC that will be assigned by the Health Care Financing Administration (HCFA). The hospital must code a facility service level using the HCPCS codes and submit that on the UB-92. The professional component of the patients visit will still be billed as it is now using CPT codes. The professional procedure codes and E/M codes will not change. Nursing service and procedure coding will have to be more precise, and charges need to be assigned on a line basis in order to truly reflect the degree of care provided by the nurses.

Any procedures performed in the ED by either the ED physician or private physician will also be identified with an appropriate HCPCS/CPT code and billed as a line item. They will, in turn, be paid by Medicare under the assigned APC payment for each service.

Reader Question answered by Jack Turner, MD, PhD, of Team Health, a documentation and coding compliance firm in Knoxville,Tenn., and Caral Edelberg, CPC, CCS-P, president of Medical Management Resources, a training and consulting firm in Jacksonville, Fla.