tci ED Coding & Reimbursement Alert - 2001 Issue 6

Reader Question: Facility E/M Levels

Question: How should I code E/M levels for a facility? Do most facilities use the same HCFA guidelines that apply to the professional fee?Rich SobierayBlue & Company, IndianapolisAnswer: HCFA has instructed that each facility may set its own guidelines for determining the facility E/M for ED visits, as long as the levels are tiered to reflect acuity and resources. Very few facilities have used the professional-component physician documentation guidelines to establish nursing criteria because those guidelines do not accurately reflect the resources required by the facility to provide ED care. There is no expectation that the physician E/M...

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