Part B Insider - 2015 Issue 12
You Be the Coder: What Qualifies as ER POS?
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Article Overview
This coding Q&A explains how to think about outpatient hospital versus emergency room place of service reporting for a hospital-based encounter, and how that distinction affects evaluation and management code selection. It is aimed at coders and billers who need to understand how registration status and setting influence claim reporting. The article also references the role of medical necessity and the general level of service documented for the visit.
Why This Topic Matters
Accurate place of service and visit code selection affects claim accuracy and helps avoid reporting a higher-acuity emergency department service when the patient was not formally an ER patient.
What You Will Learn
- How place of service selection can depend on the patient’s registration status in the hospital setting.
- How hospital outpatient and emergency department visit categories differ at a high level.
- How the documented level of service is tied to reported evaluation and management coding in this scenario.
- Why the setting of care matters for claim reporting when a physician sees a patient urgently in a hospital environment.
Who Should Read This
- Medical coders
- Billing staff
- Revenue cycle professionals
- Physician practices
- Hospital outpatient billing teams
Codes Discussed
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