Medical coding forms the backbone of the revenue cycle. Maintaining efficient clinical documentation and medical processes is an ongoing challenge for the emergency departments of hospitals. The fast-paced nature of the emergency department provides physicians with little time for clinical documentation. New coding updates rolling in is only going to add layers of complexity to an already challenging process. But like the answer to most complex problems the solution can lie in the smaller details. The little changes and tweaks you bring into the medical coding process can be a game-changer.
It is essential to develop training programs for emergency physicians to improve clinical documentation and code capture. It can be a struggle to assign medical codes for professional services due to ever evolving regulatory requirements. Physician documentation forms the cornerstone of effective medical coding and educating physicians, to a large extent, helps in optimizing reimbursement and increasing emergency coding accuracy.
Emergency department coding consists of both professional and facility coding. The ability to analyze documentation to determine the right ED service level. The service level depends on various factors such as medical decision making complexity and medical history of the patient. This make assigning appropriate service levels a challenge. Most hospitals follow a pre-designed grid to avoid confusion. It is best practice to update the grid/point system followed in line with current norms. An ED coding model that centers on three important parameters can act as a guardrail and prevent workarounds or errors. The three important parameters being:
Patient history
Examination details
Medical decision making complexity
Modifiers play a crucial role in maximizing reimbursement and avoiding claim denials. Modifiers indicate the specific circumstances in which medical services were rendered and play a pivotal role in reimbursement. They qualify codes and poor understanding of modifiers result in money left on the table.
ED coders are typically overwhelmed with the sheer volume of codes that need to be assigned everyday. Identifying and storing documentation improvement opportunities help in improving ED coding specificity and bubbling up missed documentation. Standardizing the clinical documentation and medical coding process improves coding accuracy and revenue capture. It also offers physicians a framework to fall back on.
It is essential for ED medical coders to code to the highest level of specificity. To code in the appropriate sequential order is important to gain appropriate reimbursement. To identify the most appropriate condition that necessitated the ED visit and assign codes requires broad and deep knowledge of the emergency department medical coding space.
There are a few common ED coding mistakes, such as…
Assigning codes for services that were performed outside the emergency department on ED specific claims.
Inappropriate use of modifiers.
Missed classification of ED services and observation care. It requires supporting documentation to indicate medical necessity for ED stays.
ED codes are reported per day. It is important to understand the 5 levels of emergency department services to assign timely and accurate codes.
Failure to indicate clearly start and stop times on facility claims.
The major reason for ED claim denials is the lack of documentation that proves medical necessity. It is essential to ascertain diagnosis specificity to avoid claim denials. It requires experience to correctly specify the diagnosis that necessitated the ED visit/stay. Coding the sequential order of diagnosis and focusing on the highest degree of specificity requires specialized skills and years of experience.
Do you know the emergency department coding changes that were made in 2021? The answer to this question can determine the financial health of your hospital. This is why it is now more important than ever to work with coding teams that don’t just understand but excel at ED coding.
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