Unlike professional/physician services, the evaluation and management levels in a facility are not determined by history, exam and medical decision making. The levels are determined by the utilization of hospital resources and is used only in the emergency department. It is not necessary that the same level be reported as the physician service level. All visits are based on facility services, not the physician.
Lacking a standardized reporting system, the levels are determined by assigning a point system to hospital resources.
The only requirements are that the services must be documented in the record and that they must meet medical necessity. Orders from the physician for interventions and/or diagnostics must be clearly supported.
Learning Objectives:
- Understand how Emergency Department facility E/M levels differ from professional/physician E/M coding
- Learn how facility E/M levels are determined based on hospital resource utilization, not history, exam, and medical decision making
- Understand why the facility level and the physician level do not have to match for the same ED visit
- Learn how a point system is used to assign E/M levels in the Emergency Department
- Understand the documentation requirements that support facility E/M level assignment
- Recognize the importance of medical necessity when assigning facility E/M levels
- Identify the role of physician orders for interventions and diagnostics in supporting the level reported
Areas Covered in the Session:
- Understand how points may be assigned to meet code levels 99281 – 99285 & Critical Care in the Emergency Department
- Review examples of each level
- Clarify purpose of the charge
- These services include costs & expenses not separately reportable
- Emphasize that all facility services billed must be clearly documented in the medical record
- Reinforce that all services must meet the standard of medical necessity
- Highlight that physician orders for interventions and diagnostics must be clearly supported by documentation
- Clarify that facility E/M levels do not need to match the physician’s professional E/M level for the same visit
- Live Q&A Session
Suggested Attendees:
- Revenue Cycle Managers & Staff
- Billers
- Coders
- Clinical Documentation Staff
- Finance Managers
- Denial Management Staff
- Physicians
- Mid Level Providers
- Claims Follow Up Staff
Presenter Biography:
Dorothy D. Steed, MSLD, CCS, CDIP, COC, CPCO, CPUM, CPUR, CPHM, CPMA, ACS-OP, CCS-P, RCC, RMC, CEMC, CPC-I, CFPC, PCS, FCS, CRCR, CICA, CPAR, is an Independent Healthcare Consultant and Educator. She has served as Medicare specialist and a physician audit supervisor for hospital systems with 49 years of experience in healthcare. She is an instructor at a state technical college in Georgia and provides auditing & training in both facility and physician services. She is credentialed in medical coding, medical billing, medical auditing, utilization management, healthcare management, healthcare compliance, clinical documentation improvement, revenue cycle and patient accounts. Additionally, she has participated in multiple healthcare audits and investigations for both plaintiff and defendant.
