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Emergency Department Coding (facility)

Description

Facility coding guidelines are inherently different from professional coding guidelines. Facility coding reflects the volume and intensity of resources utilized by the facility to provide patient care, whereas professional codes are determined based on the complexity and intensity of provider performed work and include the cognitive effort expended by the provider.  As such, there is no definitive strong correlation between facility and professional coding and thus no rational basis for the application of one set of derived codes, either facility or professional, to the determination of the other on a case-by-case basis.  

At this point, there is no national standard for hospital assignment of E&M code levels for outpatient services in clinics and the Emergency Department (ED). CMS requires each hospital to establish its own facility billing guidelines.  Further, OPPS lists eleven criteria that must be met for facility billing guidelines.  Facility billing guidelines should be designed to reasonably relate the intensity of hospital services to the different levels of effort represented by the codes. Coding guidelines should be based on facility resources, should be clear to facilitate accurate payments, should only require documentation that is clinically necessary for patient care, and should not facilitate upcoding or gaming.  For further information, see the 2009 CMS Final Rule for facility billing. A summary of the OPPS rule is available on the ACEP website.

What Will I Learn?

  •  Pragmatic learning approach
  •  Assessments/polls and feedback (very critical)
  •  Chart dissection process (learn from scratch)
  •  Chart coding and code capturing skills
  •  Case presentation activities (builds confidence)
  •  Acquire ‘Defend your code’ skills (audit purpose)
  •  Interview preps

Topics for this course

100h

ED facility coding basics

Facility vs professional coding concepts

ACEP guidelines introduction

ED level (1 to 5) coding

Critical care coding

Hydration and infusions coding

Therapeutic and diagnostic drug infusion coding

IV pushes

Chemotherapy and injection coding

ED bedside procedure coding

Lumbar Puncture, wound repairs

Epistaxis, I&D’s

FB removals, aspirations

ET intubation, tracheotomies, nerve blocks

Fx treatments, foleys, burn care coding

Modifiers

25,000.00

Requirements

  • Candidates should have basic
  • work experience in medical
  • coding
  •  Should have exposure using
  • the code sets ICD-10-CM and
  • CPT
  •  Basic knowledge in handling
  • Microsoft word and excel
  •  Coders from HCC/E&M
  • background will have added
  • advantage
  •  Certified – non experienced
  • can be selected
  •  Noncertified – experience
  • folks can be selected
  •  Learnability skills
  •  Analytical and problem-
  • solving skills
  •  Enthusiastic and proactive in
  • learning approach
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