# Er Charging Help?



## kst73pkvw (Feb 17, 2012)

I am charging an ER and need help.  Pt. Presented with low back pain, leg pain and  history of Sickle Cell Anemia. The physicians Dx is Sickle Cell Anemia.
Pt has received IV pushes, Iv Additional Pushes, and Sequential IV same med pushes. He has also received a blood transfusion  2 units of Packed Rbc's while in the Er, after pt is stabilized he is then discharged home.(10 hours later)

Can I charge an E & M Level as well as the Transfusion? and are the pushes considered Additional instead of initial due to the transfusion?

Help?


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## jmcpolin (Feb 23, 2012)

ksteinke@cmhosp.com sorry for that extremely rude person, did the phys treat the pt for the back and leg pain as well?  Just curious


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## mitchellde (Feb 23, 2012)

ksteinke@cmhosp.com said:


> I am charging an ER and need help.  Pt. Presented with low back pain, leg pain and  history of Sickle Cell Anemia. The physicians Dx is Sickle Cell Anemia.
> Pt has received IV pushes, Iv Additional Pushes, and Sequential IV same med pushes. He has also received a blood transfusion  2 units of Packed Rbc's while in the Er, after pt is stabilized he is then discharged home.(10 hours later)
> 
> Can I charge an E & M Level as well as the Transfusion? and are the pushes considered Additional instead of initial due to the transfusion?
> ...



We are here to help... Having said that we need some additional infor to be of optimal assistance.  You need to let us know if you are billing for the physician or the facility.  And some additional information from the documentation would be helpful.  For instance the symptoms may have alerted the provider to investigate for the anemia.  So the symptoms then would be part of the end dx.  Now if you are coding for the facility then the visit level will be dependent on your facility criteria, and on the face of things yes you have enough criteria met to charge a level with the 25 modifier which you will need as IV administration is a status S procedure code.  I honestly do not remember if the transfusion trumps the pushes but that info is in the CPT book in the infusion section, if it is not addressed at all in the hierarchy then code the pushes first.
I hope the above response did not cause you to turn away fromthe forums as a means of help it is why we are here.


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## jmcpolin (Feb 23, 2012)

Thanks Debra, I feel like sometimes it is a competetion on here to prove who is smarter and to make others feel stupid.  One of my pet peaves is when coders forget where they came from and feel superior because they have more experience or knowledge.  I feel like I am still learnng and as long as I am a coder will continue to learn.


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## mitchellde (Feb 23, 2012)

I am like you Jenifer I learn everyday!  Something about responses like that just ruffles my feathers!!


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## jmcpolin (Feb 23, 2012)

Well you can tell by my response I was a little upset lol


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