# ED Coding and E/M with procedures?



## jifnif (Aug 17, 2010)

I am new to ED coding but not new to E/M coding.  My question is what can be billed in the ED?  Meds administered po?  Spirometry?  Splinting?  X-rays?  Blood draw for CBC?  Is there anything that is not billable in ED might be a better way to put it.  Also, I am looking for resources that are ED specific, any suggestions?  Thank you!!!


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## mitchellde (Aug 17, 2010)

are you billing for the physician or the facility?


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## jifnif (Aug 17, 2010)

physician.  but i wanted to know who bills for what in most instances.  like if a ed doc does a blood transfusion who bills: ed or facility?  same with all of the above situations.  Where do i find these guidelines or are they just know?


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## jifnif (Aug 17, 2010)

also, what drugs are billable and what are not?  if the pt is administered amoxil po would you code?  injection for a drug?


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## jimbo1231 (Aug 17, 2010)

*Physician/Facility*

If you are coding on the physician side some of what you listed would not be coded. The key on the physician side for coding procedures is that the physician must personally do or closely mange the procedure. Meds administered PO is a factor in MDM but not coded on physician side. Drugs are typically coded on facility side with J codes but not on physician side. X-Ray if the ED physician interperted and documented can be coded but sometimes isn't depending on the payer and what kind of deal the radiologists have with the hospital. Spirometry is rare by the ED doc and personally drawing blood is rare. But if doc does it OK.
A good starting point might be the CcEDC practicum that AAPC offers. if the physician applied the splint ok to code....but if ordered only that is on facility side.

Jim


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## modal (Aug 22, 2010)

Hi Jifnif:

Most of the things you mention are billed by the facility (ie the hospital) not the ER physician.

Even the hospital does not bill oral medication administration. It's included in the facility E/M code. Nursing work involved in injections and infusions are also facility codes only. Blood draws are usually facility charges. The drugs themselves are billed by the facility (J codes). Transfusions are ordered by the physician, not usually personally performed by the physician-so they are facility codes.

Physician billing is mainly E/M levels 99281-99285 plus 99291, 992921 critical care.

Major procedures coded for physician billing would include fracture management, wound repair, I&D, FB removal, joint reduction, joint aspiration, chest tube placement, emergency endotracheal  intubation, central line placement etc. Coding for splinting and casting are tricky- modifiers and codes depend on whether the doc is providing complete care for the problem or temporizing until patient can see a specialist.

Wish there was a book just for the ER-maybe Ingenix should write one!

I hung out at a number of discussion boards and took several webinars when I started. The AAPC specialty course for Emegency Department coding should also help.

Good luck!


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## mitchellde (Aug 22, 2010)

Just think of whose resources are involved directly.  If it is the facilities drugs then they bill for them if it is ordered by the physician yet performed by the facility staff then the facility bills for it.  If the physician performs it then the physician and the facility bill for it.   It really just comes down to who is expending the resource.   If the physician orders blood work then the facility personnel draws it and the facility lab runs the test.  the physician interprest the result which is a component of his MDM. so he gets an E&M, the facility codes an E&M as well plus the venipuncture plus the lab test.  If the physician orders an injection then he can include the drug management as part of his MDM so he can charge an E&M, the facility charges an E&M plus the injection admin plus the drug.  And so on.  It is really not as hard as it sounds.


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