tci ED Coding & Reimbursement Alert - 2016 Issue 10

Reader Question: Don't Count on CMS to Guide Facility Level Selection

Question: Does CMS have documentation guidelines for the facility level of ED service similar to those of the professional side? Maryland Subscriber Answer: Since the introduction of the OPPS concept at the turn of the century, CMS has declined to publish or endorse any guidelines for selecting the ED facility level. 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’s work, including the cognitive effort expended in...

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