# New coder looking for guidance



## mabauer1 (Oct 12, 2011)

Hello,

I graduated just this past July with my Associate's degree in medical billing and coding. I am going to be starting a position coding emergency department records and there are a few areas I feel my classes did not prepare me for adequately.  I will be coding for the facility.  My confusion lies in the use of E/M codes.  For example, in the following case what, if any E/M codes would be required:

Physician notes:
Right index finger and Dorsum of middle phalanx - sensory/motor intact. Nail intact. All joints numbed w/ 1% lidocaine and the wound thoroughly scrubbed & irrigated.  Wound edges sharp.  No debridement necessary.  Sutured w/ 2 interrupted sutures of 4-O nylon.  D/C home. Recheck in 8-10.  Keep clean & dry. Return if any evidence of infection or problem. Tylenol prn pain.

I am thinking there should be a facility E/M code.  A procedure code for the suturing, but I am not sure if there is an E/M code required for the physician as well (assuming the physician is employed by the hospital). 

Can anyone offer any guidance?


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## kvangoor (Oct 12, 2011)

It depends on the place of service. If they were seen in the ER, use the 9928X codes plus any procedure codes. Do you have a CPT book you could look at? I would read the E/m guidelines in the front of the book.


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## mabauer1 (Oct 12, 2011)

I do have a CPT book.  This was one of my practice cases from school.  I coded it using a 9928x code and the procedure code and my instructor said I didn't need the E/M code because a procedure was done.  That is what is confusing me.  I guess what I am asking is do you always use an E/M code when a patient is seen in the E.R.  despite whether or not there is a procedure or procedures performed?


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## rewhite2 (Oct 12, 2011)

*E/R Coding*

There will always be an E/M code with patients seen in the E/R - no matter what procedures are done.. Just make sure appropriate modifiers are used if necessary...


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## mitchellde (Oct 12, 2011)

I disagree,there is not always an E&M code in the ER, the same criteria applies to the facility that applies to the provider, the resourses used must be over above and beyond the procedure.  With this note and noting else I see no E&M for the physician nor for the facility.  The only assesment provided by the physician was what was necessary for the procedure and the only resources used by the facility is what was needed for the procedure.  The facility E&M however will be dependent also on the facility assessment tool which you will not have until it is provided by the facility as each facility can develope a different criteria for E&M assesment and it is not the 95 or 97 guidelines which are for the physician.


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## mabauer1 (Oct 12, 2011)

In this practice case we had nursing documentation given :

Allergies : no
Current Meds: n/a
Pulse 68
PMH: asthma
Assessment : 0.5cmlac to R 2nd finger @ d.p. no bleeding Bactoshield NS wash


We also were given Physician Orders:

Polysporin 2 x2, 2" Kling
Bandage

Aside from the Physician Notes I posted earlier that is it.  So if I follow you correctly in this case there would be no E/M code for the physician, however there could be a "facility E/M" charge?


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## mitchellde (Oct 12, 2011)

Yes that is correct, the physician E&M and the facility E&M do not have to match, as different criteria is being evaluated however the procedure codes do have to match.


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## mabauer1 (Oct 12, 2011)

Thank you so much.  It makes a little more sense to me now.  I am quite nervous about knowing when to use the E/M codes.  That seems to be my major hangup.


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## Sueedwards (Oct 15, 2011)

In the back of the CPT book there are also some examples of E/M's that will be great for you to read and see how they are being coded.


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## mitchellde (Oct 15, 2011)

Yes but that applies to the physician only, facility E&Ms are different so keep that in mind.  The facility is required to have their own criteria developed for determining the E&M level and it may not be the same from one facility to the other.


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## jimbo1231 (Oct 19, 2011)

*laceration*

Just an FYI, you also need a length for the laceration which I'm assuming is somewhere else in the chart.

Jim


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