ljones88
Networker
Hi all,
Recently I was told by a department head at my job that COPA is to be determined based on "how the patient presented to the department/office" when determining the level of the COPA....I can't find any documentation anywhere within the AMA CPT, or CMS stating that COPA is to be determined based on how the patient presented to the department. I was always told COPA is simply the complexity of the problems addressed- nothing to do with how the patient presented. I am specifically referring to the E/M Leveling under the 2023 E/M Guidelines wherein COPA (Complexity of Problems Addressed), Risk, and Data are considered in leveling the E/M visit.
This is the example we are being given in order to understand this rationale: Patient presented to the ED with wrist pain. Without the dr knowing what happened to the patient, and knowing additional workup will need to be done, they are telling us we should be considering this wrist pain as a Moderate level COPA falling under either an "acute complicated injury" or "undiagnosed new problem with uncertain prognosis" regardless of the final diagnosis (in this case, just some wrist pain likely from arthritis, no fractures, or vascular issues).
I'm sorry, but what?! Needless to say I asked for evidence as to where this directive is coming from and I get no answers. Further, they are taking into consideration what the ACEP (American College of Emergency Physicians) in their logic/rationale....With all due respect, ACEP is no one on the totem pole of authority. They have zero influence on the CMS and CPT rules so of course, when I questioned why this department is considering ACEP's interpretation of the rules as fact, no one could give me an answer....This is the first time in my 14 years of coding that any organization has used ACEP in their logic/rationale....everywhere I have worked always refers to CMS or AMA's CPT only. SO here I am asking the general public if anyone can provide proof that COPA is to be determined based on how the patient first presented to the department. The math aint mathin in my search efforts and I have lost so much sleep over this cause it will inadvertently lead to overcoding and risk the organization to an OIG audit.
Recently I was told by a department head at my job that COPA is to be determined based on "how the patient presented to the department/office" when determining the level of the COPA....I can't find any documentation anywhere within the AMA CPT, or CMS stating that COPA is to be determined based on how the patient presented to the department. I was always told COPA is simply the complexity of the problems addressed- nothing to do with how the patient presented. I am specifically referring to the E/M Leveling under the 2023 E/M Guidelines wherein COPA (Complexity of Problems Addressed), Risk, and Data are considered in leveling the E/M visit.
This is the example we are being given in order to understand this rationale: Patient presented to the ED with wrist pain. Without the dr knowing what happened to the patient, and knowing additional workup will need to be done, they are telling us we should be considering this wrist pain as a Moderate level COPA falling under either an "acute complicated injury" or "undiagnosed new problem with uncertain prognosis" regardless of the final diagnosis (in this case, just some wrist pain likely from arthritis, no fractures, or vascular issues).
I'm sorry, but what?! Needless to say I asked for evidence as to where this directive is coming from and I get no answers. Further, they are taking into consideration what the ACEP (American College of Emergency Physicians) in their logic/rationale....With all due respect, ACEP is no one on the totem pole of authority. They have zero influence on the CMS and CPT rules so of course, when I questioned why this department is considering ACEP's interpretation of the rules as fact, no one could give me an answer....This is the first time in my 14 years of coding that any organization has used ACEP in their logic/rationale....everywhere I have worked always refers to CMS or AMA's CPT only. SO here I am asking the general public if anyone can provide proof that COPA is to be determined based on how the patient first presented to the department. The math aint mathin in my search efforts and I have lost so much sleep over this cause it will inadvertently lead to overcoding and risk the organization to an OIG audit.
Last edited: