E/M Hospital and ED Visits

The autocoder codes hospital inpatient and observation E/M visits and emergency department visits. It uses the same method as office visits: an extraction step quotes the supporting evidence verbatim from the chart, and a deterministic engine picks the level from that evidence. The autocoder never picks a level by judgment.

Codes the autocoder can produce

The autocoder never assigns 99281 automatically. It carries no medical decision making basis, so the engine leaves it out of the emergency department family.

Hospital charts and clinic charts arrive as the same note types today, such as a history and physical note or a progress note. Both the office extraction and the hospital extraction can therefore run on one chart. The autocoder then picks the billing lane deterministically.

The hospital lane wins only when the chart carries a setting quote that names inpatient, observation, or emergency department care, and that quote matches the chart text. Otherwise the office lane applies. The autocoder records the pick and its basis on the claim, and raises the E/M coding lane selected alert (INFORMATIONAL, default severity 3) so a coder can confirm the site of service.

Emergency department packets qualify for coding through the SummaryForEmergencyMedicine note type. Your facility configuration controls the qualifying list through the qualifyingEncounterNotes.anyOf setting. A facility override replaces that list in full, so an override must name the emergency department note type as well. Contact your Hank representative to change it.

The 8-hour stay rule

Length of stay decides two outcomes, and the autocoder applies both from admission and discharge times that it quotes from the chart.

Same-date admission and discharge codes 99234-99236 need documented times that show a stay of 8 hours or more and less than 24 hours. When the times are missing, contradictory, or prove a shorter stay, the autocoder levels the visit as initial or subsequent hospital care instead. It raises the same-date admission/discharge downgraded alert (COMPLIANCE, default severity 6). Every 99234-99236 claim also gets the same-date documentation requirements alert (COMPLIANCE, default severity 6).

When the quoted times prove a stay of less than 8 hours, the autocoder suppresses discharge day management and builds no E/M line from that chart. It raises the discharge day management not separately billable alert (HARDSTOP, default severity 8) and records the suppression reasons on the claim. Verify the documented times first. Correct them in the record if they are wrong, then reprocess the chart.

Other alerts on this lane

• Discharge time not documented tells a coder that 99238 was applied because the chart records no discharge-day time. Type INFORMATIONAL, default severity 3.
• ED visit bundled into hospital admission asks a coder to confirm that no separate emergency department claim goes out for the same practitioner and date. Type COMPLIANCE, default severity 6.
• Consultant on observation patient asks a coder to check the payer rule before submission. Type COMPLIANCE, default severity 6.
• Hospital lane selected but no level supportable asks a coder to confirm the true site of service. The claim carries the office-lane code instead. Type COMPLIANCE, default severity 6.
• Initial hospital care without cited first-encounter evidence asks a coder to confirm the visit is not a subsequent visit. Type COMPLIANCE, default severity 5.

On hospital-lane claims, the prolonged-time alert names 99418 and G0316 when documented time may support a prolonged service that the claim does not carry.

How this reaches you

What happens next depends on how your organization consumes HANK CODES. In HANK Claim Maker, a HARDSTOP alert places the claim in the review queue your administrators configured for it. Organizations that consume the coding API directly decide in their own workflow which alerts pause a claim, who reviews them, and when a claim is released.