CODING CORNER: Test Yourself-Submitting Flawless Bills In the ED

See if you can spot the errors in these examples
If you think your emergency department (ED) isn't receiving all the reimbursement it deserves (hint: most EDs aren't), inspect these expert-supplied bills care-fully to see if you can prevent denials before they reach the payer.
Bill #1: A Medicare patient presents in the ED with a stiff neck, headache, vomiting, and fever. The ED physician ordered intravenous NS, 25 mg of IV Demerol, 12.5 mg of IV Phenergan, labs, and a computed tomography (CT) scan of the head. She consulted a private physician who performed a spinal tap in the ED. What's wrong with this bill?
 
Answer #1: This bill contains several major slipups, says Caral Edelberg, CPC, CCS-P, president of Medical Management Resources in Jacksonville, Fla. The first: The coder should have included the spinal tap (62270, Spinal puncture, lumbar, diagnostic), using revenue center 450, even though a private physician performed the procedure and not the ED doctor.

In addition, while the coder billed the correct IV injection codes under revenue center 450, she also needs to list the medications on the bill: Demerol (J2175) and Phenergan (J2550) under revenue center 250 (Pharmacy). This revenue center also applies to J7030, normal saline, although some payers may accept the 260 (IV therapy) as well, says Sarah L. Goodman, MBA, CPC-H, CCP, president of SLG Inc. in Raleigh, N.C. According to the April 4, 2000, edition of the Federal Register (page 18497), you should be sure to list drugs even if they're not separately payable under the outpatient prospective payment system (OPPS), because services under revenue code 250 apply to outlier payments.
Also, always remember to append modifier -25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) to the evaluation and management (E/M) code when applicable, says Edelberg, who presented on ED coding for facilities at the American Academy of Professional Coders 12th Annual Conference. In this case, Q0081 (Infusion therapy, using other than chemotherapeutic drugs, per visit) and 62270 have status indicators "S" and "T," which make the latter subject to reduction and allows you to append modifier -25 to the E/M code.
Furthermore, the CT scan of the head, although another department performed it, should be reported with one of the following codes, depending on whether contrast was used: 70450 (Computed tomography, head or brain; without contrast material), 70460 (Computed tomography, head or brain; with contrast material[s]), or 70470 (Computed tomography, head or brain; without contrast material, followed by contrast material[s] and further sections). You shouldn't report the two lab codes - 80050 (General health panel) and 80051 (Electrolyte panel) - together unless [...]

- Published on 2005-01-01