Emergency Department (ED) Evaluation and Management Coding Policy.

Ensuring transparent and accurate reimbursement practices

To ensure transparent, timely, and accurate reimbursement practices aligned with regulatory requirements, industry standards, and best practices in claims management, Martin’s Point is introducing a new reimbursement policy:

Emergency Department (ED) Evaluation and Management (E/M) Coding Policy

As part of the implementation of this policy, Martin’s Point will utilize Optum’s Emergency Department Claim (EDC) Analyzer tool, which determines appropriate E/M coding levels based on data from the patient’s claim including the following:

• Patient’s presenting problem
• Diagnostic services performed during the visit
• Any patient complicating conditions

To learn more about the EDC Analyzer™ tool, please visit EDCAnalyzer.com.

If you have any questions regarding this policy, please contact Martin’s Point Provider Inquiry at 1-888-732-7364.