AAPC - Advancing the Business of Healthcare

Emergency Department Audit: Effects of 2023 EM Guidelines

Case Study

In the complex world of healthcare reimbursement, accurate billing and coding for Emergency Department (ED) services is essential for financial integrity and regulatory compliance. Explore our latest case study, where we examine the impacts of the 2023 EM Guidelines on ED coding and billing. Learn about the common issues, including over-coding and under-coding, and gain practical guidance to enhance your documentation accuracy. 

Highlights include: 

  • Audit results from 103 providers and 1,173 ED E/M codes 

  • An overall accuracy score of 86% for CPT E/M levels 

  • Importance of accurate ICD-10-CM code selection

About the author

Lori Cox

Lori Cox has over 25 years of experience working in the business side of healthcare. She began her career in patient accounts and then moved into billing and coding for a multispecialty clinic. She was eventually promoted to billing supervisor and then to compliance officer, where she wrote, maintained, and trained employees and providers on fraud and abuse. Currently, Cox works for AAPC Services as Director of Client Engagement, performing audits and education for clients across the U.S. She has spoken at HEALTHCON and regional conferences and has traveled the country educating coders and physicians on complex coding topics such as hem/onc and E/M guidelines. Cox is the past member relations officer for AAPC’s National Advisory Board.

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