# does the px go first or the level?



## Karen Powell (Sep 17, 2008)

Does anyone know if there is a guideline to a certain order you are supposed to list the ER levels with a procedure? For exampe if pt had laceration of finger and level 3 ER visit which way are you supposed to list them? 
12001-883.0
99283(25) 883.0

or
99283(25)883.0
12001-883.0

I thought you are supposed to list the more expensive procedure first then go in descending order, but another coder I work with said you always code the E/M first for ER. I'm not sure this is right. 
Thank you for the help,
Karen


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## bettyboopsandy (Sep 17, 2008)

Well the physician needs to examine the patient first and has to decide if some sort of repair is required. I have always used the E&m first than the procedure.


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## cisaac (Sep 17, 2008)

In my experience, the only time it matters which procedure code goes first is when there is the possibility of multiple surgery rules which would pay the first procedure at 100% and the second at 50%, then you want to make sure the procedure with the highest rvu's gets reimbursed at 100%


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## Karen Powell (Sep 17, 2008)

So I keep the er level 1st then the px second? what if there is more than on px ? for example fx toe, laceration finger and level. Do I list level, fx, then laceration?


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## 808coder (Sep 18, 2008)

*E/M + procedures*

hi!

Always list theE/M (99281-99291) first; always append mod -25 to them for procedures done by ED MD.

2nd, your highest paying RVU goes first followed by lowest RVU's.  Fractures usually pay more than a suture, best to check your RVU.  

If you don't have this book by Ingenix "Emergency Medicine Coding Companion" good one to have.  If you are coding for ED they should get you one.  Very helpful

Good Luck!


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