Billing and Insurances

Exposure to billing and coding in emergency medicine residency is varied and often remains confusing at the time of graduation. The following chapter discusses how our cognitive work and medical decision-making (MDM) are translated into Current Procedural Terminology (CPT) codes, assigned a standard unit of work, and eventually tied to monetary value. Recent and significant updates to the Evaluation and Management (E/M) guidelines stress the importance of documenting our medical decision-making in an accurate and clear manner that conveys the complexity of the emergency department (ED) encounter without the burden of an overly detailed history and physical exam. Small changes to documentation can have large implications for reimbursement and prevent billing at lower levels than warranted.