Emergency Department E/M distribution
Does anyone have a recommendation on what the distribution should be for facility emergency department E/M charging? I am just looking for guidelines of what we typically would expect especially for level 3, 4, and 5. I understand this differs from facility size but looking for anyone willing to share their distribution or industry guidelines. Thanks
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Feel free to email me: tracy.boldt@essentiahealth.org
@cmartin189
Industry standards state there should be a bell curve w/ 99283 at the peak
Just have to say it- your code distribution should be what it is when every patient's visit is coded properly. There is no right distribution!
Do your patients have access to urgent care centers and community physicians with easy access for minor issues? Then you'll have less low level visits.
Is your payer mix predominantly poor paying plans like Medicaid along with many uninsured where your ED is the only place to get care? Then your distribution will include many more lower level visits.
I have studied this for years. CMS would love to see a bell curve so they don't pay as much. It can differ on your mix of patients, region, type of facility, etc. For example, a small community hospital may have higher distribution to levels 4 and 5 due to the need to transfer for traumas, behavioral health or specialty care outside of their abilities. Where an academic medical center may actually have lower levels in their distribution due to the rate of "primary care" type visits and faster paths to admission for more critical patients.