Part B Insider - 2012 Issue 5
Reader Question: Medicare Doesn't Expect Hospital and ER Doc Codes to Match
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Article Overview
This article addresses a common Medicare coding question involving evaluation and management billing by hospitals and physicians in the emergency setting. It explains the general relationship between facility and professional coding, and references CMS and the AMA in discussing why the two claim types are treated as separate systems. The piece is useful for coders, billing staff, and compliance readers who need a quick clarification on how Medicare views code alignment between entities.
Why This Topic Matters
Understanding the distinction between hospital and physician coding helps reduce billing confusion and supports cleaner claims and compliance review in emergency department settings.
What You Will Learn
- How Medicare views the relationship between hospital and physician evaluation and management coding
- Why facility and professional billing are treated as separate coding systems
- Which organizations are referenced in the discussion of Medicare coding expectations
- What general issue the article clarifies about code alignment across entities
Who Should Read This
- Medical coders
- Billing specialists
- Compliance staff
- Emergency department revenue cycle teams
- Physician practice managers
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