Facility Coding- How Effective is Your Point System?

As there is currently no national standard for point systems, hospitals are required to develop and follow their own system for assigning the ED levels. When you do this, be sure that there are written guidelines with criteria for coding each of the five levels of ED codes, as well as for critical care.

The point system should utilize a consistent methodology for assigning an ED facility level that is based on the work performed by the ED staff. The point system should exclude any services or procedures that are billed separately.

What should be considered when developing a facility point system?

• Accuracy

• · Reproducible- interpreted and implied in a consistent manner

• Correlation with the resources utilized to provide a given service, such as employee wages and benefits and facility costs

What is meant by facility costs?

Facility costs consist of overhead and most supplies and medications. The ED code should reflect the intensity of the hospital services that you are providing.

With the whole point system for facility ED billing there are many moving parts to consider. Some of the questions that facilities should ask themselves regarding their point systems:

1. How was our ED point system established?
   

2. Is our point system correctly accounting for all the resources that we are actually utilizing in our ED?
   

3. Is our point system including resources that are separately billable and actually should not be included in that point system?

4. Are all the staff members accurately and consistently interpreting how our point system is being used, as well as how it is actually intended to be used?