Digging Into HIM & Coding Blog

For many, the ins and outs of facility evaluation and management (E/M) coding for emergency department (ED) services are shrouded in mystery.  In an industry where everything seems to be regulated, there appears to be a lack of regulation in the world of facility ED E/M.  But is there really?  I’ve been known to fib a little about facility ED E/M coding but quickly backtrack to simply state, “It’s complicated.”  So without further ado, here are three little lies I’ve told about facility E/M coding and the real truths behind them.

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Additional Tips & Expertise

Q: Are off-campus emergency departments Type A or Type B EDs?

Q: Should a “fast track” area of an ED be reported as Type A or Type B? The fast track area is not open 24 hours a day but it is located within an ED that is. What about if the fast track area is used for overflow during busy times?

Q: You referred to modifier 25 for use with other procedure codes. This modifier is for a significant, separately identifiable E/M service by the same physician or qualified health care professional (QHP) on the same day of the procedure or other service. Isn’t this only applicable to the pro-fee setting?

Featured Education

No Rules For Facility E/M Levels Webinar

When it comes to coding evaluation and management services in the hospitals, the rules are there are no national rules and you can make up your own. But CMS published 11 criteria to ensure that services aren’t reported in duplicate. Join this webinar to learn how facility levels should be determined and validated and make sure you are compliant.

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