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Answer :
Final answer:
The statement that all Emergency Department (ED) patients are considered new and require a 3 of 3 elements for billing is false. ED coding relies more on the visit's complexity, including factors like visit acuity and resources used, rather than fitting a strict set of criteria.
Explanation:
The statement "All ED (Emergency Department) patients are considered new patients that require 3 of 3 elements on the coding table to select the overall ED level for billing" is False. In emergency department billing, the patient's status as 'new' or 'established' does not affect coding levels as it does in other clinical settings. Instead, ED coding typically relies on the complexity of the visit, which is determined by a combination of factors such as the patient's history, physical examination, and decision-making complexity.
The Comprehensive Error Rate Testing (CERT) program and various payer guidelines suggest that while some elements may overlap with those used in outpatient settings, the specifics can vary significantly. For example, in outpatient settings, billing levels might indeed require meeting criteria out of a 3 of 3 table (history, examination, and medical decision-making), but in the emergency department, the emphasis is more often placed on the acuity of the visit and resources utilized during care.
Therefore, the process for selecting the overall ED level for billing purposes is not as straightforward as requiring a specific number of elements from a table. Each ED visit is unique, and coders must consider a variety of factors, including but not limited to the intensity of services provided, the patient's presenting problems, and the utilisation of hospital resources.
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