tci ED Coding & Reimbursement Alert - 2000 Issue 6

Clarify Services by Revising ED Assessment Criteria

By Caral L. Edelberg, CPC, CCS-PPresident, Medical Management Resources Inc.Consulting EditorWith the publication of the outpatient prospective payment system/ambulatory payment classification (OPPS/APC) final regulations, the major controversy over required matching of the emergency department (ED) physician evaluation and management (E/M) level to the ED facility level was resolved with this statement, Therefore, we would not expect to see a high degree of correlation between the code reported by the physician and that reported by the facility.The challenge to hospitals now will be to revise the existing facility assessment criteria that will crosswalk to the emergency department evaluation...

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