Emergency Medicine Coders: Don’t Miss These 3 Trending Areas!

There have been some hot topics in recent issues of TCI’s Emergency Department Coding & Reimbursement Alert that are just too good not to share. Here’s a quick summary with links to the articles for you lucky readers with access to the online newsletter or to Emergency Medicine Coder.

1. Streamline With This Change to Student E/M Documentation

Teaching hospital staff got some relief from an update to CMS’s position on medical student participation in E/M service documentation. The way providers must perform encounters hasn’t changed, but the shift allows the teaching physician to “verify in the medical record all student documentation or findings, including history, physical exam and/or medical decision making.” Note the term “verify” in that rule. In the past, the teaching physician would have had to re-document those elements. The hope is that this change will save providers time on meeting medical record requirements.

Tip: Read the article for more information and to get a bullet-point plan you can use in your ED.

2. Beware This Potential Cause of Anthem ED Denials

Anthem Blue Cross Blue Shield has added more states to its policy of denying ED claims for non-emergent conditions. In short, if a patient goes to the ED for a non-emergency, Anthem will review the claim using the “prudent layperson standard,” meaning someone with average health and medicine knowledge. If the review determines the patient should have gone somewhere other than the ED and none of the exceptions to the policy apply, Anthem will deny the claim as “member liability.”

Tips: Read the article for a summary of what some of the reactions to the policy have been.

3. Are You Part of the $315 Million Part B Improper Payment Problem?

Emergency medicine’s improper payment rate (12.7 percent) looks to be higher than the overall improper payment rate (10.2 percent). That’s according to the 2017 CERT report, which estimates $315.3 million in improper payments for EDs. Both underpayments and overpayments are improper, so your plan to steer clear of payment issues should be focused on coding appropriately to capture every dollar, but not a dollar more. Code 99285 is a hot spot right now, so that’s a good place to start.

Tip: Read the article to see examples of common issues with ED visit codes and how to avoid those troublemakers.

What About You?

What brought you to emergency medicine coding? What new rules did you have to learn for this specialty? What issues are you and your staff talking about now?


Deborah works on a wide range of TCI SuperCoder projects, researching and writing about coding, as well as assisting with data updates and tool development for our online coding solutions. Since joining TCI in 2004, she’s covered the ins and outs of coding for radiology, cardiology, oncology and hematology, orthopedics, audiology, and more.

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