ED Coding and Reimbursement Alert
Procedure or ED E/M?:
Use This Guidance for Treating Lacerations With Surgicel
Report with wound repair codes, include in E/M code … or something else? Laceration re... Read more
Use This Guidance for Treating Lacerations With Surgicel
Report with wound repair codes, include in E/M code … or something else? Laceration re... Read more
CPT® Basics:
Decipher the Symbols in Your CPT® Code Book for Easier Code Selection
These notations can help coders better master each code's guidelines and descriptors. E... Read more
Decipher the Symbols in Your CPT® Code Book for Easier Code Selection
These notations can help coders better master each code's guidelines and descriptors. E... Read more
ICD-10 Coding:
Update Your Understanding of Asthma Coding
And don't forget cause/effect sequencing. Earlier this year, the Centers for Disease Con... Read more
Update Your Understanding of Asthma Coding
And don't forget cause/effect sequencing. Earlier this year, the Centers for Disease Con... Read more
You Be the Coder:
CPR, E/M for CHF Patient
Question: The physician spent 41 minutes treating a patient with chronic congestive h... Read more
CPR, E/M for CHF Patient
Question: The physician spent 41 minutes treating a patient with chronic congestive h... Read more
Reader Questions:
Complicated I&D Depends on Physician Judgment
Question: Encounter notes indicate that the ED physician performed an incision and dr... Read more
Complicated I&D Depends on Physician Judgment
Question: Encounter notes indicate that the ED physician performed an incision and dr... Read more
Reader Questions:
Use This Primer to Ease Hypertension Coding
Question: What is the difference between essential (primary) hypertension and seconda... Read more
Use This Primer to Ease Hypertension Coding
Question: What is the difference between essential (primary) hypertension and seconda... Read more
Reader Questions:
Distinguish NCD From LCD
Question: What's the difference between a national coverage determination (NCD) and ... Read more
Distinguish NCD From LCD
Question: What's the difference between a national coverage determination (NCD) and ... Read more
Reader Questions:
Get the 411 on MUE
Question: Could you please clarify what “MUE” means and explain how it impacts m... Read more
Get the 411 on MUE
Question: Could you please clarify what “MUE” means and explain how it impacts m... Read more
ICD-10 2025:
ICD-10 Makes Eating Disorders More Specific
Also, synovitis/tenosynovitis combo code expands. ICD-10 has released its list of new, re... Read more
ICD-10 Makes Eating Disorders More Specific
Also, synovitis/tenosynovitis combo code expands. ICD-10 has released its list of new, re... Read more
Medicare Physician Fee Schedule:
Here’s the Big News in the 2025 Proposed Rule
Big surprise: Another rate cut is coming. The Centers for Medicare & Medicaid Service... Read more
Here’s the Big News in the 2025 Proposed Rule
Big surprise: Another rate cut is coming. The Centers for Medicare & Medicaid Service... Read more
Modifier Madness:
4 Tips to Help You Differentiate Modifiers 76, 77
4 Tips to Help You Differentiate Modifiers 76, 77 Repeat service, but 2 different provid... Read more
4 Tips to Help You Differentiate Modifiers 76, 77
4 Tips to Help You Differentiate Modifiers 76, 77 Repeat service, but 2 different provid... Read more
Reader Questions:
Know Difference Between Closed Clavicle Treatments
Question: Encounter notes indicate that a patient suffered from a fracture of their ... Read more
Know Difference Between Closed Clavicle Treatments
Question: Encounter notes indicate that a patient suffered from a fracture of their ... Read more
Reader Questions:
Think Beyond Reimbursement for Z Codes and Medical Necessity
Question: Do Z codes really affect reimbursement, or are they mostly designed to pad ... Read more
Think Beyond Reimbursement for Z Codes and Medical Necessity
Question: Do Z codes really affect reimbursement, or are they mostly designed to pad ... Read more
Reader Questions:
Rely on Addendums for EHR Mistake Corrections
Question: How should we correct a mistake in an electronic health record (EHR)? Mont... Read more
Rely on Addendums for EHR Mistake Corrections
Question: How should we correct a mistake in an electronic health record (EHR)? Mont... Read more
Reader Questions:
Reevaluate the Relationship Between Unlisted Codes and Modifiers
Question: Can I append a modifier to an unlisted CPT® code? I'm having trouble gett... Read more
Reevaluate the Relationship Between Unlisted Codes and Modifiers
Question: Can I append a modifier to an unlisted CPT® code? I'm having trouble gett... Read more
You Be the Coder:
Simple or Complicated FBR?
Question: A patient reports to the ED after falling into a pile of branches while lan... Read more
Simple or Complicated FBR?
Question: A patient reports to the ED after falling into a pile of branches while lan... Read more
Injections:
FYI on TPI: Know When You Can Code These Shots in the ED
Remember to count muscles injected. Therapeutic injections and infusions aren't typically... Read more
FYI on TPI: Know When You Can Code These Shots in the ED
Remember to count muscles injected. Therapeutic injections and infusions aren't typically... Read more
Mythbuster:
Shatter These 4 Myths, Strengthen Signs and Symptoms Smarts
Get the 411 on what to code – and what to leave off – your claims. Choosing the ICD-1... Read more
Shatter These 4 Myths, Strengthen Signs and Symptoms Smarts
Get the 411 on what to code – and what to leave off – your claims. Choosing the ICD-1... Read more
Compliance:
Address These Key Fields, Complete ABNs With Ease
Don't forget that every ABN form must be one single page. As every ED practice is aware,... Read more
Address These Key Fields, Complete ABNs With Ease
Don't forget that every ABN form must be one single page. As every ED practice is aware,... Read more
Reader Questions:
Choose E/M for Bruised Chest and Ribs Tx
Question: A new patient presents to the ED after falling from a balcony. The patient... Read more
Choose E/M for Bruised Chest and Ribs Tx
Question: A new patient presents to the ED after falling from a balcony. The patient... Read more
Reader Questions:
Distinguish Medical Identity Theft From Other Types of Fraud
Question: Is medical identity theft a type of fraudulent claim? Minnesota Subscriber... Read more
Distinguish Medical Identity Theft From Other Types of Fraud
Question: Is medical identity theft a type of fraudulent claim? Minnesota Subscriber... Read more
Reader Questions:
Get Delta-Agent Info on Hepatitis Dx
Question: Encounter notes indicate that the ED physician treated a patient with “ac... Read more
Get Delta-Agent Info on Hepatitis Dx
Question: Encounter notes indicate that the ED physician treated a patient with “ac... Read more
You Be the Coder:
TBSA Counting Methods for Burns
Question: Encounter notes indicate that an adult patient suffered burns to their righ... Read more
TBSA Counting Methods for Burns
Question: Encounter notes indicate that an adult patient suffered burns to their righ... Read more
Fracture Care Coding:
Close Knowledge Gap to Master These Closed Fracture Treatments
Some ED fractures require manipulation; others don't. Two common fracture presentations i... Read more
Close Knowledge Gap to Master These Closed Fracture Treatments
Some ED fractures require manipulation; others don't. Two common fracture presentations i... Read more
Fee-For-Time Billing:
7 Myths and 1 Truth About Fee-for-Time Billing
Prep now for summer fee-for-time fill-ins, previously called locum tenens. Summer vacati... Read more
7 Myths and 1 Truth About Fee-for-Time Billing
Prep now for summer fee-for-time fill-ins, previously called locum tenens. Summer vacati... Read more
Compliance:
Fight for Your Right to Appeal and Win
Insurance companies aren't advocating for your office; that's your job. During her HEALTH... Read more
Fight for Your Right to Appeal and Win
Insurance companies aren't advocating for your office; that's your job. During her HEALTH... Read more
Reader Questions:
Don’t Combine Chest Pain, SOB Symptoms
Question: A patient reports to the ED with chest pain and shortness of breath (SOB).... Read more
Don’t Combine Chest Pain, SOB Symptoms
Question: A patient reports to the ED with chest pain and shortness of breath (SOB).... Read more
Reader Questions:
Get the Skinny on Medicare Overpayment Timeline
Question: We've heard that Centers for Medicare & Medicaid Services (CMS) says we... Read more
Get the Skinny on Medicare Overpayment Timeline
Question: We've heard that Centers for Medicare & Medicaid Services (CMS) says we... Read more
Reader Questions:
Be Careful With Complexity for Undiagnosed Condition
Question: Does an undiagnosed new problem with uncertain diagnosis automatically mean... Read more
Be Careful With Complexity for Undiagnosed Condition
Question: Does an undiagnosed new problem with uncertain diagnosis automatically mean... Read more
You Be the Coder:
A-lines and Critical Care
Question: A patient with acute respiratory failure with hypoxia is brought to the ED ... Read more
A-lines and Critical Care
Question: A patient with acute respiratory failure with hypoxia is brought to the ED ... Read more
Condition Spotlight:
Cool Off Burn Coding Concerns by Knowing Treatment Types
Know when to report a procedure code for burn care. In the last issue, we ran down the m... Read more
Cool Off Burn Coding Concerns by Knowing Treatment Types
Know when to report a procedure code for burn care. In the last issue, we ran down the m... Read more
Modifiers:
Avoid These 5 Modifier 59 Errors to Keep Pay Flowing
Plus: Find out the 2024 news that changes one modifier 59 rule. What would you do if 40... Read more
Avoid These 5 Modifier 59 Errors to Keep Pay Flowing
Plus: Find out the 2024 news that changes one modifier 59 rule. What would you do if 40... Read more
Compliance:
Study These Strategies for Setting Up a Solid CDI Process
Realize the benefits of regular self-audits. Comprehensive clinical documentation is the ... Read more
Study These Strategies for Setting Up a Solid CDI Process
Realize the benefits of regular self-audits. Comprehensive clinical documentation is the ... Read more
Reader Questions:
Know Thoracentesis Definition for Clearer Coding
Question: Encounter notes indicate that the ED physician inserted a long needle into ... Read more
Know Thoracentesis Definition for Clearer Coding
Question: Encounter notes indicate that the ED physician inserted a long needle into ... Read more
Reader Questions:
Make Friends With ‘Buddy Taping’ Code
Question: If the ED physician wraps tape around an injured toe and an adjoining one t... Read more
Make Friends With ‘Buddy Taping’ Code
Question: If the ED physician wraps tape around an injured toe and an adjoining one t... Read more
Reader Questions:
Define Stable Condition
Question: Is there any difference between a chronic condition and a stable condition,... Read more
Define Stable Condition
Question: Is there any difference between a chronic condition and a stable condition,... Read more
Reader Questions:
Use NOS Code for Backache Dx
Question: If a patient is diagnosed with “backache” and there is no other informa... Read more
Use NOS Code for Backache Dx
Question: If a patient is diagnosed with “backache” and there is no other informa... Read more
You Be the Coder:
Is This an Intubation?
Question: A patient is brought to the ED with chronic obstructive pulmonary disease (... Read more
Is This an Intubation?
Question: A patient is brought to the ED with chronic obstructive pulmonary disease (... Read more
ICD-10 Coding:
Follow These Steps to Burn Coding Success
Corrosion or burn? Here's why it matters. Patients who report to the ED with burns have a... Read more
Follow These Steps to Burn Coding Success
Corrosion or burn? Here's why it matters. Patients who report to the ED with burns have a... Read more
E/M Coding:
Take a Second Look at MDM Table
Does data factor into this ED E/M claim? Given the recent and extensive changes to the ev... Read more
Take a Second Look at MDM Table
Does data factor into this ED E/M claim? Given the recent and extensive changes to the ev... Read more
Cybersecurity:
Stay on Top of Cyber Threats As You Introduce New Tech and Services
Bookmark the HC3 webpage for quick access to federal guidance. With the rise of telehea... Read more
Stay on Top of Cyber Threats As You Introduce New Tech and Services
Bookmark the HC3 webpage for quick access to federal guidance. With the rise of telehea... Read more
Reader Questions:
Keep CPR, E/M Separate
Question: Can I report an ED evaluation and management (E/M) code along with a code for ca... Read more
Keep CPR, E/M Separate
Question: Can I report an ED evaluation and management (E/M) code along with a code for ca... Read more
Reader Questions:
Medicare Ups Conversion Factor … Slightly
Question: Has there been any change to the Medicare Physician Fee Schedule (MPFS) conversi... Read more
Medicare Ups Conversion Factor … Slightly
Question: Has there been any change to the Medicare Physician Fee Schedule (MPFS) conversi... Read more
Reader Questions:
Gather Info for Accurate AAA Dx
Question: A patient reports to the ED with complaints of severe back pain, clammy skin, an... Read more
Gather Info for Accurate AAA Dx
Question: A patient reports to the ED with complaints of severe back pain, clammy skin, an... Read more
Reader Questions:
Know When ‘Procedures’ Don’t Get Procedure Codes
Question: One of my providers recently removed an ear piercing, and he documented that “... Read more
Know When ‘Procedures’ Don’t Get Procedure Codes
Question: One of my providers recently removed an ear piercing, and he documented that “... Read more
Reader Questions:
Determine Whether to Code Dementia With Alzheimer’s Diagnosis
Question: Dementia is a symptom of Alzheimer's, so does that mean I can't code them togeth... Read more
Determine Whether to Code Dementia With Alzheimer’s Diagnosis
Question: Dementia is a symptom of Alzheimer's, so does that mean I can't code them togeth... Read more
You Be the Coder:
Fracture by Assault
Question: Encounter notes indicate that a patient reported to the ED after someone assault... Read more
Fracture by Assault
Question: Encounter notes indicate that a patient reported to the ED after someone assault... Read more
News You Can Use:
Use Updated Guidelines to Allow for Multiple Unlisted Procedures
Also, CPT® updates modifiers you can — and can't — use with unlisted codes. If... Read more
Use Updated Guidelines to Allow for Multiple Unlisted Procedures
Also, CPT® updates modifiers you can — and can't — use with unlisted codes. If... Read more
ICD-10 Coding:
Prep for Warm-Weather ED Presentations With These Tips
Anaphylactic shock a factor in insect bite coding. It seems to be getting warmer earlier... Read more
Prep for Warm-Weather ED Presentations With These Tips
Anaphylactic shock a factor in insect bite coding. It seems to be getting warmer earlier... Read more
Case Study Corner:
Listen Up for Cerumen Removal Advice
Do you know what instruments the physician might use? When a patient reports to the ED ... Read more
Listen Up for Cerumen Removal Advice
Do you know what instruments the physician might use? When a patient reports to the ED ... Read more
Reader Questions:
Drill Down for Details on Head Crush Injury
Question: Encounter notes indicate that a patient suffers from a crushing injury of t... Read more
Drill Down for Details on Head Crush Injury
Question: Encounter notes indicate that a patient suffers from a crushing injury of t... Read more
Reader Questions:
Make Modifiers Work for You on Lesion Removal
Question: After a level-three ED evaluation and management (E/M) service, the physici... Read more
Make Modifiers Work for You on Lesion Removal
Question: After a level-three ED evaluation and management (E/M) service, the physici... Read more
Reader Questions:
Note Procedure Details to I.D. Abscess Drainage Type
Question: What is the difference between a simple and complicated finger abscess drai... Read more
Note Procedure Details to I.D. Abscess Drainage Type
Question: What is the difference between a simple and complicated finger abscess drai... Read more
You Be the Coder:
ED E/M With Critical Care
Question: A patient reports to the ED with chest pain. During the course of an ED eva... Read more
ED E/M With Critical Care
Question: A patient reports to the ED with chest pain. During the course of an ED eva... Read more
Injection Coding:
Know Joint Size for Accurate Arthrocentesis Coding
Use nebulous CPT® descriptors as guidepost for other joints. Patients who report to the ... Read more
Know Joint Size for Accurate Arthrocentesis Coding
Use nebulous CPT® descriptors as guidepost for other joints. Patients who report to the ... Read more
ICD-10 Coding:
Get Specifics to Nail Hypertensive Disease Dx
Here's the code to use for essential hypertension. When patients are suffering from a hyp... Read more
Get Specifics to Nail Hypertensive Disease Dx
Here's the code to use for essential hypertension. When patients are suffering from a hyp... Read more
E/M Coding:
Rehash Hospital Coding Rules to Ensure Compliance
Do you know which hospital services share codes now? In case you haven't noticed, CPT® ... Read more
Rehash Hospital Coding Rules to Ensure Compliance
Do you know which hospital services share codes now? In case you haven't noticed, CPT® ... Read more
Reader Questions:
Never Report Prolonged ED E/M Services
Question: Is there a way to account for extra time on an ED evaluation and managemen... Read more
Never Report Prolonged ED E/M Services
Question: Is there a way to account for extra time on an ED evaluation and managemen... Read more
Reader Questions:
Know Complication Type to Choose Dx
Question: If a patient suffers from an intra- or postoperative complication involving... Read more
Know Complication Type to Choose Dx
Question: If a patient suffers from an intra- or postoperative complication involving... Read more
Reader Questions:
These 2 Effusions Get 1 ICD-10 Code
Question: If a patient suffers from effusion of the same ankle and foot, should I sub... Read more
These 2 Effusions Get 1 ICD-10 Code
Question: If a patient suffers from effusion of the same ankle and foot, should I sub... Read more
Reader Questions:
Know Stages for Optimal Pressure Ulcer Coding
Question: If a patient has a pressure ulcer on their back, what is the difference amo... Read more
Know Stages for Optimal Pressure Ulcer Coding
Question: If a patient has a pressure ulcer on their back, what is the difference amo... Read more
You Be the Coder:
Critical Care Time
Question: I have an encounter form in front of me that's a bit confusing. Notes indic... Read more
Critical Care Time
Question: I have an encounter form in front of me that's a bit confusing. Notes indic... Read more
E/M Coding:
Time Is of the Essence When Reporting Critical Care
Know how to count critical care minutes. Proper documentation and coding of critical care... Read more
Time Is of the Essence When Reporting Critical Care
Know how to count critical care minutes. Proper documentation and coding of critical care... Read more
Compliance:
Make Sure Fairness Marks Sanction Policy
Tip: Ensure employees receive training equivalent to their duties. Data breaches are ser... Read more
Make Sure Fairness Marks Sanction Policy
Tip: Ensure employees receive training equivalent to their duties. Data breaches are ser... Read more
ICD-10 Coding:
Use These Tips to Get Top Neurology Diagnoses Out of Your Head
Do you know how to code headache syndromes? In an ED, there are going to be a number of... Read more
Use These Tips to Get Top Neurology Diagnoses Out of Your Head
Do you know how to code headache syndromes? In an ED, there are going to be a number of... Read more
Reader Questions:
Get More Info to Before Picking PICC Code
Question: Encounter notes indicate that the ED physician inserted a peripherally inse... Read more
Get More Info to Before Picking PICC Code
Question: Encounter notes indicate that the ED physician inserted a peripherally inse... Read more
Reader Questions:
Report Manipulation Along With Palmar Fascial Cord Injection
Question: Encounter notes indicate that the ED physician injected collagenase for a ... Read more
Report Manipulation Along With Palmar Fascial Cord Injection
Question: Encounter notes indicate that the ED physician injected collagenase for a ... Read more
Reader Questions:
Don’t Treat All Fatigue Syndromes the Same
Question: Are all fatigue syndromes the same, for diagnosis purposes? For example, if... Read more
Don’t Treat All Fatigue Syndromes the Same
Question: Are all fatigue syndromes the same, for diagnosis purposes? For example, if... Read more
You Be the Coder:
Separate E/M With Minor Procedure
Question: A patient reports to the ED with an ingrown toenail. During the exam, the p... Read more
Separate E/M With Minor Procedure
Question: A patient reports to the ED with an ingrown toenail. During the exam, the p... Read more
2024 MPFS:
CMS Aligns With CPT® on Split/Shared Visits
See how the change will affect MDM scoring. In 2024, the stars will align and CPT® and M... Read more
CMS Aligns With CPT® on Split/Shared Visits
See how the change will affect MDM scoring. In 2024, the stars will align and CPT® and M... Read more
2024 MPFS:
CMS Follows Through With CF Cut
Here's what factored into the final decrease. It's happened again. With no one displayi... Read more
CMS Follows Through With CF Cut
Here's what factored into the final decrease. It's happened again. With no one displayi... Read more
Procedure Coding:
Spark Your Burn Coding With CPT® Smarts
Do you know when burn Tx isn't reported with a burn Tx code? When a patient reports to th... Read more
Spark Your Burn Coding With CPT® Smarts
Do you know when burn Tx isn't reported with a burn Tx code? When a patient reports to th... Read more
Reader Question:
Know Specifics of Chickenpox for Optimal Code Selection
Question: Encounter notes indicate that the ED physician treated a patient with “cx... Read more
Know Specifics of Chickenpox for Optimal Code Selection
Question: Encounter notes indicate that the ED physician treated a patient with “cx... Read more
Reader Question:
Allergy to Cement? Report This Dx
Question: When a patient has allergic contact dermatitis to cement dust, how should I... Read more
Allergy to Cement? Report This Dx
Question: When a patient has allergic contact dermatitis to cement dust, how should I... Read more
Reader Question:
Code Carefully When Considering CPR/Critical Care Combo
Question: Encounter notes indicate that the ED physician performed 43 minutes of crit... Read more
Code Carefully When Considering CPR/Critical Care Combo
Question: Encounter notes indicate that the ED physician performed 43 minutes of crit... Read more
Reader Question:
Consider Independent Historian When Seeking Px Info
Question: I am working as a coder for the first time and one of my providers wrote th... Read more
Consider Independent Historian When Seeking Px Info
Question: I am working as a coder for the first time and one of my providers wrote th... Read more
You Be the Coder:
Multiple Laceration Repairs
Question: Encounter notes indicate that the ED physician treated two wounds to a pati... Read more
Multiple Laceration Repairs
Question: Encounter notes indicate that the ED physician treated two wounds to a pati... Read more
Emergency Department:
Consider Complexities of Encounter on Nosebleed, Earwax Encounters
Remember the rules for procedure coding on these common services. Sometimes, how you code... Read more
Consider Complexities of Encounter on Nosebleed, Earwax Encounters
Remember the rules for procedure coding on these common services. Sometimes, how you code... Read more
Emergency Department:
Repeat Rabies Vax Presents E/M Coding Challenges
Question: Our office is currently engaged in a debate regarding the appropriate codin... Read more
Repeat Rabies Vax Presents E/M Coding Challenges
Question: Our office is currently engaged in a debate regarding the appropriate codin... Read more
Emergency Department Coding:
Check 5th Character Requirements on Liver Disease Dx
Question: When a patient suffers from alcoholic liver disease, what is the best way t... Read more
Check 5th Character Requirements on Liver Disease Dx
Question: When a patient suffers from alcoholic liver disease, what is the best way t... Read more