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The emergency room is oftentimes the very first place that potential patients arrive at a hospital. They are sometimes hurt seriously and will need to be admitted to the hospital for inpatient treatment or transferred to another hospital. Emergency departments are ranked on a one to four scale that determines trauma levels. One is the highest level of a trauma center.

What Is Emergency Room Coding?

This is the process of assessing a patient’s diagnosis and ranking it appropriately based on diagnosis, treatment, and prospective payments. Coders classify all of these figures and bill a patient based on the Hospital Outpatient Prospective Payment System (OPPS). The coders use Ambulatory Payment Classifications (APCs) to determine where in the OPPS a patient falls.

Ambulatory Payment Classification

Ambulatory Payment Classifications (APCs) are the federal method in the United States to pay for services within the Medicare system. APCs are only applicable to hospital outpatient services. There are other methods by which a physician is reimbursed in the United States. Though APCs were originally created for determining Medicare payments, the standards are applied by some state programs, by Medicaid, and by some private health insurance firms. The streamlined process makes the job of coders more straightforward.

Guidelines

Emergency room coding guidelines vary from hospital to hospital, so it can be very difficult for a coder to properly determine how to code a certain patient’s services. Many facilities adhere to the OPPS and the APCs applicable therein, so it’s merely a matter of a coder being well versed in the statutes.

Coders have the unenviable task of considering every single documented procedure whether it is by a nurse or a physician. They are must also review a physician’s notes. They must also be very well versed in the medical field to properly assess how the diagnosis relates to the treatment and whether it was warranted. Also, the notes and documentation will have medical procedure codes and diagnosis codes. The coder must read the codes and determine the necessity of the resulting procedures. Also, there are no national or federal standards for what defines a necessary procedure and what doesn’t. That means every management service has to set its own guidelines. This can get very complex very quickly since there is no widespread standard. In fact, the codes between a hospital and a physician, even one with admitting privileges to the hospital, could be different. Determining the proper amount to bill a patient requires intricate knowledge of medical procedures and the medical field. Because of that, it is advisable to hire a firm that is experienced in coding and billing. These management companies can allow you to rest assured that you are getting the best coding and billing services that are available.