ED Coding and Reimbursement Alert

Most hospitals are getting used to the idea of fee-schedule reimbursement for outpatient services, but few are prepared for the imposition of line-item coding on Jan. 1, 2001, according to Caral Edelberg, CPC, CCS-P, president of Medical Management Resources, an emergency department coding consulting firm in Jacksonville, Fla. Although hospitals can bundle now-itemized procedure charges, that loophole ends in a few months and facility revenue will be threatened.

How will this affect emergency department (ED) coders? First, they will have to draw on more documentation to assign visit codes. Second, they must learn and use a host of CPT and ICD-9 codes they never had to use before. Third, they will have to learn how to use the ambulatory payment classifications (APC) rules to ensure appropriate revenue for the hospital.

The ED is unlike any other department in the hospital in that every patient is new and nobody has an appointment. Those differences make the ED particularly vulnerable to the effects of APCs, which affect all facility outpatient coding and billing. In fact, at most hospitals, the emergency department will be the hardest hit by the new Medicare outpatient prospective payment system (OPPS).

APCs will require EDs to make a lot of organizational changes, and coders will not be immune from the effects. But theres no need to panic. Coders just need to use a little extra caution and become familiar with the new rules, and they can help smooth the transition to APCs.

Most hospitals APC teams contain at least one representative from the coding department and at least one from the ED clinical staff, so the people who will be hardest hit by these changes will be taken into account during the planning.

In the past, many EDs simply mirrored physician coding and never set up criteria for visit levels, says Kelly Kracher, manager of oncology services at the Nebraska Health System in Omaha. Some hospitals mirrored and some will choose to continue to mirror. You just have to create a system thats consistent.

For many hospitals, a consistent system will revolve around nursing documentation, she says. Because some facilities currently require minimal documentation from nurses, the additional documentation will add complexity to the job of the coder.

This new emphasis on nursing documentation will help EDs better capture the resources being used. Sometimes the physician comes in and spends 10 minutes with the patient, but the nurse could spend more than an hour discussing everything from disease etiology to medication management to family counseling, Kracher says. Nurses also may be required to keep track of supplies and other often-unrecorded matters.

In addition to physician and nursing documentation, Kracher says that ED coders will have to [...]