Reimbursement FAQs

The ACEP Coding Nomenclature Advisory Committee (CNAC) and Reimbursement Committee (R/C) have developed and approved these frequently asked questions (FAQs) as educational resources to assist emergency physicians in improving their coding and documentation practices.

CNAC and R/C are comprised of emergency physicians and coding professionals with expertise in coding and billing for emergency physician services. These committees’ primary function is to interpret and provide advice on coding and billing rules and documentation for emergency medicine, referencing guidelines from the Centers for Medicare and Medicaid Services (CMS), the American Medical Association (AMA), and other pertinent bodies. They assess how these standards may influence the emergency medicine field and formulate strategies to ensure precise and fitting coding and documentation.

They are tasked with staying abreast of the ever-evolving landscape of coding regulations, policy shifts, and reimbursement processes and with aiding emergency physicians in staying up-to-date with these changes. Collaborating with various ACEP committees and external parties, including government agencies and coding organizations, the committees advocate for just coding and billing practices in emergency medicine. Moreover, the committees dedicate themselves to educating physicians through the creation of coding resources, articles, workshops, and webinars, aiming to enhance coding proficiency, minimize errors, and promote the highest quality of emergency medical care.

The FAQs and Pearls are crafted by experts, reviewed by a committee, and reflect contemporary coding standards as of the date they were reviewed. ACEP notes that while it strives for accuracy, it cannot assure that all information in these resources is entirely accurate, comprehensive, or current.  In addition, coding guidance offered in FAQs or Pearls may not align with individual payer policies or local hospital coding protocols.

The information provided in the FAQs and Pearls is offered without any guarantees or warranties, whether stated or implied, including but not limited to, the implied warranties of merchantability and fitness for a particular purpose. Payer policies should follow CPT guidance, however payment policy may differ based on contractual agreements between physicians and payers. Payment policies may differ among various payers. The American College of Emergency Physicians (ACEP), along with its officers, directors, committee members, authors, and editors, do not accept any responsibility or liability for any potential damages resulting from the application, absence of application, interpretation, or reliance on the information included or excluded from the FAQs and Pearls.  ACEP will not be responsible for any direct, indirect, incidental, special, or consequential damages that may arise from use of the information included in the FAQs and Pearls. If you have specific questions related to coding or payment, we advise that you contact the payer directly.

Should you require additional details or wish to offer feedback, please contact David A. McKenzie, the Director of Reimbursement for ACEP, at (469) 499-0133, or email dmckenzie@acep.org.