How do hospitals determine which Evaluation and Management service levels to assign for ED and clinic services-as they relate to APCs and other payment methodologies?
At this point, there is no “national standard” for hospital assignment of E&M code levels for outpatient services in clinics and the ED. CMS has stated that each hospital may utilize its own unique system for assignment of E&M levels, provided that the services are medically necessary, the coding methodology is accurate, consistently reproducible, and correlates with institutional resources utilized to provide a given level of service. In 2007 CMS established a lower level of ED called a Type B ED for services offered in a facility based ED that was not open 24×7. See the November 27, 2007 Federal Register for further discussion on Type and B EDs http://edocket.access.gpo.gov/2007/pdf/07-5507.pdf While there are no specific CMS national guidelines CMS has given providers direction in the form of general guidelines including the following: • The coding guidelines should follow the intent of the CPT code descriptor in that the guidelines should be designed to reasonably relate the intens
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