Not Enough Beds? How to Handle ED Boarders

Why This Topic Matters

Boarding can shift significant inpatient-level work into the emergency department setting, creating potential reimbursement and documentation issues if the service is not captured correctly. Understanding the general coding and recordkeeping framework can help organizations better align payment with the work performed.

Article Sections

1. Prepare for the Trend

   This section describes the broader hospital staffing and capacity pressures contributing to emergency department boarding. It frames the operational context for the billing issues discussed later in the article.

2. A new class of patients

   This section defines the general boarding scenario and explains why these patients remain in the emergency department after admission. It focuses on the setting and responsibilities involved.

3. Don't Dismiss the Work

   This section discusses the types of ongoing services that may continue while the patient remains boarded in the emergency department. It emphasizes the need to recognize the work performed even after transfer of care.

4. May the Best Code Set Win

   This section reviews broad evaluation and management coding options for additional work in the boarding situation. It also addresses documentation considerations associated with choosing among the available service categories.

5. Watch your back

   This section focuses on record flow and billing workflow concerns tied to emergency department documentation. It highlights the importance of ensuring the service note reaches the appropriate billing process.