Part B Insider - 2012 Issue 9
You Be the Coder: Should I use an established patient code for a known patient?
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Article Overview
This coding Q&A explains how emergency department patient status is viewed for E/M reporting and why prior visits do not necessarily change ED coding. It is aimed at coders, billers, and compliance staff who work with facility or professional emergency department documentation and need to understand broad E/M selection considerations, documentation elements, and risk-based level assignment.
Why This Topic Matters
Emergency department coding can differ from office-based established-patient logic, so misunderstanding patient status can lead to incorrect E/M code selection. The article helps readers recognize that ED visits are evaluated under ED-specific reporting concepts and documentation standards.
What You Will Learn
- How emergency department patient status is treated for E/M reporting
- What general documentation elements influence ED visit level selection
- How risk and presenting problems factor into ED coding discussions
- Why repeated prior ED visits do not automatically change ED patient classification
Who Should Read This
- Medical coders
- Emergency department billers
- Compliance staff
- Revenue cycle staff
- Physician documentation specialists
Codes Discussed
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