mdfoster
New
In trying to explain the difference between facility & physician ER E/M coding to superiors within my organization, I have presented the following:
•HCPCS/CPT codes = a way to adequately describe level of physician effort (evaluation and management, including history, exam, medical decision making)
•HCPCS/CPT codes do not = a way to adequately describe non-physician resources (ER room time, ancillary services, nursing, imaging, etc.)
Therefore, a direct correlation between facility E/M billing & physician E/M billing cannot be made.
I have pointed out:
•CMS has NOT issued national guidelines for E/M coding.
•CMS HAS indicated that hospital must develop a mapping system (65 FR 18451)].
•Each facility must follow its own system which "reasonably relates the intensity of hospital resources to the different levels of HCPCS codes." CMS has indicated that it "would not expect to see a high degree of correlation between the code reported by the physician and that reported by the facility." (65 FR 18451)
Am I correct in thinking that without a given facility's ER mapping logic, an "audit" of E/M (facility) would not be accurate? Thanks for any feedback.
•HCPCS/CPT codes = a way to adequately describe level of physician effort (evaluation and management, including history, exam, medical decision making)
•HCPCS/CPT codes do not = a way to adequately describe non-physician resources (ER room time, ancillary services, nursing, imaging, etc.)
Therefore, a direct correlation between facility E/M billing & physician E/M billing cannot be made.
I have pointed out:
•CMS has NOT issued national guidelines for E/M coding.
•CMS HAS indicated that hospital must develop a mapping system (65 FR 18451)].
•Each facility must follow its own system which "reasonably relates the intensity of hospital resources to the different levels of HCPCS codes." CMS has indicated that it "would not expect to see a high degree of correlation between the code reported by the physician and that reported by the facility." (65 FR 18451)
Am I correct in thinking that without a given facility's ER mapping logic, an "audit" of E/M (facility) would not be accurate? Thanks for any feedback.