ED Coding and Reimbursement Alert

Question: I heard that the National Correct Coding Initiative released the newest version of its edits recently. Are there any edits that will affect ED coders?

Maryland Subscriber
 
Answer: NCCI did release its version 12.2 edits recently, and the edits will be valid on July 1. If your ED practice is also involved in hospitalist-type work and employs doctors who admit and treat patients from nursing homes, there may be some NCCI edits that interest you.
 
According to NCCI 12.2, codes 99281-99285 (Emergency department services) are considered component codes of the more global 99304-99306 codes (Initial nursing facility care).
 
So if a single physician provides a level-two ED service along with a level-two initial nursing home service, you should only report 99305 (Initial nursing facility care, per day, for the evaluation and management of a patient which requires these three key components: a comprehensive history; a comprehensive examination; and medical decision-making of moderate complexity).
 
Do not include 99282 (Emergency department visit for the evaluation and management of a patient, which requires these three key components: an expanded problem-focused history; an expanded problem-focused examination; and medical decision-making of low complexity) on the claim, because it is bundled into 99305.
 
However, this scenario may not apply to your ED. Codes 99304-99306 are new for 2006 and address the service provided when a patient is being admitted to a nursing facility. Since the ED physician typically does not also become the doctor admitting to the nursing home, this edit would not apply to many EDs.
 
Be on the lookout: For groups in which the ED physicians and the physicians who admit to the nursing home are both reporting under the same tax identification number (i.e., both work for the hospital or same multi-specialty group), keep this edit in mind when reviewing your reimbursement to make sure your services are not denied unfairly.