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BLUECONNECT
Providers
January 2024
In This Issue
► January news: Executive summary
► 2024 Medicare Advantage networks and plans
► "Incident-to" billing: What you need to know
► Updated pricing guidelines for E/M services provided in emergency departments
► Cervical cancer screening: Provider guidance for 2024
Updated pricing guideline for E/M services provided in emergency departments
Effective February 1, 2024, the Blue Cross® Blue Shield® of Arizona (AZ Blue) pricing guideline for E/M services rendered in emergency departments will follow the industry-standard recommendations by CMS and AMA. It includes the following guidance.
Leveling factors for emergency department E/M coding
Time is not considered a descriptive component in leveling E/M services provided in emergency departments. These services are typically provided on a variable intensity basis, often involving multiple encounters with several patients over an extended period of time. 

Patients in the emergency department setting should not be categorized as either new or established patients. This factor also does not come into play in leveling considerations.

For professional coding, the level of service is based on medical decision-making, complexity, severity of the presenting problem(s), and work performed (including the provider’s cognitive effort).

For facility coding, the level of service is based on the interventions performed (by department nursing and ancillary staff, not emergency physicians) for the presenting problem(s) and must reflect the volume and intensity of resources used to provide care.

See below and the new pricing guideline for examples of professional and facility coding for E/M services provided in the emergency department.
Professional coding examples for E/M services provided in emergency departments
Report services provided in the emergency department with place of service 23, along with the appropriate level-of-service code as follows:
Facility coding examples for E/M services provided in emergency departments
Report revenue code 0450, along with the appropriate level-of-service code as follows:
Please share this information with your billing teams
We ask that you share this information with your billing teams. They can access the new pricing guideline via our Claims and Remits page under Claim Pricing Guidelines-Standard > Other Standard Pricing Guidelines. If you have questions, please reach out to your Provider Relations Contact or call us at 602-864-4231 or 1-800-232-2345, ext. 4231. 
In This Issue
► January news: Executive summary
► 2024 Medicare Advantage networks and plans
► “Incident-to” billing: What you need to know
► Updated pricing guidelines for E/M services provided in emergency departments
► Cervical cancer screening: Provider guidance for 2024
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