Emergency Department Coding: Know the NOPP Levels Well to Be Bang on Target

While going about your Emergency department coding , you need to be well-versed with some key topics such as NOPP levels so that you bag the rightful reimbursements for your practice.

Without a good understanding on nature of presenting problems (NOPP) levels, you will not be able to choose the most spot on emergency coding E&M code possible for each claim. Without NOPP level, you can't decide on medical necessity for the encounter. And the important thing is Medicare and insurers will only pay for care that is 'medically necessary'. In fact, CPT defines medical necessity by the nature of presenting problem.

Get a better understanding of the five NOPP levels

According to the CPT manual, NOPP is a contributing E/M component, however not one of the vital elements. Discerning NOPP level is important; but while selecting the level of medical decision making.

The five NOPP levels are:

a) Minimal NOPP: This might not require the presence of a physician, however is provided under the physician's supervision.

b) Minor or self limited NOPP: This is not likely to change the patient's health for good; problems in this NOPP level run a proscribed course and then fade. Patients with minor or self-limited NOPP have a very low risk of morbidity minus treatment.

c) Moderate NOPP: Here, patients have a moderate risk of morbidity minus treatment, or at least an increased probability of prolonged functional impairment.

d) High NOPP: Here, patients have a big risk to extreme risk morbidity minus medical attention; a high NOPP might also involve the likelihood of severe functional impairment minus treatment.

Prior to choosing NOPP level, take a look at comorbidities

You must take a look at the condition the patient presents with along with any comorbidities so that you reach the proper NOPP level. Say for instance a patient has an NOPP of mild hypertension with slight elevation. He also suffers from lupus, a comorbidity that sends the NOPP level up. In this instance, the NOPP will be much higher because of preexisting conditions and medical history.

High NOPP doesn't always mean 99285

With five levels of NOPP at hand, it might be enticing to assume each one coincides with an emergency department E/M code; minimal NOPP equals 99281, self-limited NOPP equals 99282 and the like. However this is a dangerous coding practice.