ED Coding and Reimbursement Alert

Question: Our compliance department is pressuring the ED coders to simplify critical care coding compliance by adopting our local Medicaid carrier's critical care policies across the board. That would make sure we-re all on the same page all the time, but what are the disadvantages?

Minnesota Subscriber

Answer: Using your local Medicaid's critical care guidelines to shape your critical care coding policies and procedures might ensure you-re compliant with every payer's rules, says Caral Edelberg, CPC, CCS-P CHC, who spoke at the American Academy of Professional Coders (AAPC) National Conference in Seattle.

However, this "blanket approach" to compliance "guarantees that you-re leaving a ton of money on the table," she says. Some folks believe that you must code the same for every payer, and "you just can-t" do that unless you apply the most restrictive payer's rules to all payers. And that approach will cost you a lot in unclaimed reimbursement.