Emergency Medicine presents a unique set of challenges for coding. This fast paced high-volume specialty encompasses elements of primary care E&M services up to trauma services. Surgical procedures are performed and diagnostic tests are ordered. Diagnostic coding is critical to present the medical necessity for each. Documentation must be precise because nothing can be assumed. Unfortunately the physicians’ notes are not always expansive as they need to be; discrepancies with the doctors’ notes, the nursing notes and the doctors’ orders are commonplace. Considering the number of patient visits, the ED coders must have an intimate understanding of what happens in the ED and they must be continuously inserviced and Q/A reviewed to avoid institutionalizing misunderstandings and thus making coding errors an “intergenerational” legacy.
Emergency Medicine Coding Needs:
Well trained emergency medicine coders for both professional and facility charges in the emergency department are hard to find, expensive to hire, difficult to keep, and their “care-and-feeding” is costly.
Few emergency medicine coders are certified, a symbol of career commitment and quality coding.
Coding guidelines for the facility and professional services are complex, change often and are different for the two segments.
Coder turnover and absences create cash flow peaks and valleys.
With so few coders specializing in this niche, it is difficult to find and hire experienced emergency medicine coders, even in large metropolitan areas. EDs in smaller communities and tight labor markets have trouble filling openings and often must offer pricy sign-on bonuses or other incentives that have the potential to create friction with the existing staff.
Facility coding guidelines have no national standard. Those guidelines created by individual hospitals often undervalue services.