Wiki ER Facility E/M

[Jacoder]

I am currently trying to update our policy and procedures on our facility E/M for the ER. As we all know, the Physician side's guidelines are clearly stated, but each facility has to make their own guidelines when it comes to the facility level. We use the criteria put out by the Americian College of Emergency Physicians, but I've heard that some insurances consider it double billing when you charge for an x-ray and then use that x-ray to get the level you want. In most cases, there isn't anything to go by except what we bill for: IM/IV injections, x-rays, lab tests, ect.

So my question is this, what do you use to decide what level to assign?

 

[mitchellde]

It is correct that if there is a CPT code for the service then you cannot add it also to your facility E&M tool. We looked at the resources being used, in other words to get the patient to the x ray there was a transporter used, so we had a component (points) for the transporter, and same for a portable xray, someone had to bring it to the ER. You cannot incorporate injections into your tool as that is a separate CPT code but your nurse takes vital signs so we gave that points. So my suggestion is to look at the picture and see what is not being charged for already with CPT codes and figure out how to incorporate that into (points).

 

[Jacoder]

Thanks!