tci ED Coding & Reimbursement Alert - 2000 Issue 7

Emergency Departments Will Reap Pay Up with Signs and Symptoms Coding

Nugget: Emergency departments will gain reimbursement for diagnostic services by coding signs and symptoms along with the final diagnosis. This new rule will help justify medical necessity. Understanding the prudent layperson standard is crucial when working in an emergency room. Medicare and many insurance payers follow this federal law, which says that the patient determines the need for the visit. If the patient feels that his condition necessitates an emergency visit, then its an emergency, says Caral Edelberg, CPC, CCS-P, president of Medical Management Resources, a training and consulting firm in Jacksonville, Fla. Although the law requires that facilities...

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