The Facility-Fee Emergency Department Medical Coder is responsible for the accurate review, abstraction, and assignment of ICD-10-CM, CPT, HCPCS, facility-specific charging methodologies, and applicable modifiers for Emergency Department (ED) facility encounters. This role ensures coding accuracy, regulatory compliance, appropriate reimbursement, and adherence to client-specific coding guidelines, payer requirements, and industry standards.
The coder will review clinical documentation, emergency department records, physician documentation, nursing notes, ancillary reports, and charging information to accurately capture facility services rendered during emergency department visits. The position requires strong knowledge of facility fee coding, emergency department leveling methodologies, and outpatient reimbursement regulations.
Essential Duties and Responsibilities
- Review emergency department medical records to assign accurate ICD-10-CM diagnosis codes, CPT/HCPCS procedure codes, and applicable modifiers.
- Accurately assign facility Evaluation and Management (E/M) levels in accordance with client-specific emergency department leveling guidelines and facility charging methodologies, including knowledge of the ACEP tool.
- Analyze documentation from nursing staff, physicians, ancillary departments, and diagnostic services to ensure complete code assignment and charge capture.
- Apply official coding guidelines, CMS regulations, National Correct Coding Initiative (NCCI) edits, and payer-specific requirements.
- Review accounts for appropriate assignment of procedural services and injections/infusions when applicable.
- Identify documentation deficiencies and communicate within the appropriate channels regarding coding clarification needs.
- Maintain compliance with Medicare, Medicaid, commercial payer, and organizational coding policies.
- Participate in coding quality reviews, audits, educational initiatives, and process improvement activities.
- Remain current on coding updates, reimbursement changes, and regulatory requirements affecting emergency department facility coding.
- Collaborate with coding leadership, auditors, and client representatives to resolve coding-related issues.
To qualify you must possess:
- At least 2+ years of relevant facility-fee outpatient coding experience, specifically in Emergency Department services. Injection and Infusion experience required.
- Active AAPC or AHIMA coding certification required.
- Proven ability to work independently and efficiently in a remote environment
- Epic experience strongly preferred.
- Other facility-fee and physician-fee medical coding experience a plus