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ED Coding and Reimbursement Alert

Know Your Carriers Policy to Avoid Errors When You Bill for a Splint Applied by a Nurse or Technician
To ensure correct coding for the application of a splint by the emergency department (ED... Read more
News Brief:
HHS OIG Targets Critical Care Codes in 2001 Work Plan
The Department of Health and Human Services Office of Inspector General (OIG) has released... Read more
Medicare Increases Fees to ED Physicians for 2001
In the Nov. 1, 2000, Federal Register final rule for revisions to payment policies under ... Read more
Reader Question:
Starred Procedures
Question: Please explain a starred procedure and how it would affect billing that procedur... Read more
Reader Question:
When Length is Not Available
Question: A patient arrives in the emergency department with a crush injury to a finger: t... Read more
Reader Question:
Waiving of Coinsurance
Question: I know that Medicare considers the routine waiver of coinsurance or deductibles ... Read more
Reader Question:
Two Nosebleeds, One Day
Question: A patient is seen in the emergency department at 6 a.m. for a nosebleed. Cautery... Read more
Reader Question:
49080* vs. 49420*
Question: Codes 49080* and 49420* seem to deal with the same procedure, and other than the... Read more
Reader Question:
Teaching Physician and Ultrasounds
Question: If a teaching physician writes, Seen and examined by me. Ultrasound by me ... , ... Read more
Reader Question:
Foreign Body Removal Without Anesthesia
Question: How should I code for removal of a foreign body, vaginal, without anesthesia? Th... Read more
You Be the Coder:
Lacerations in the ED
Question: Is it correct to code an evaluation and management (E/M) code for all laceration... Read more
Justify Use of Conscious Sedation Codes With Thorough Documentation to Get Payment
Limited acceptance and tough documentation standards make coding for conscious sedation di... Read more
Avoid Coding Complications Using Fast-track ED Systems
Although the CPT codes used in fast-track emergency department (ED) services are the same ... Read more
Rules for Determining Critical Care on the Basis of Time
By Caral Edelberg, CPC, CCS-PPresident, Medical Management Resources Inc.Consulting Editor... Read more
Reader Question:
Sharp Debridements
Question: We are an outpatient wound care center in a hospital setting. Our physicians bil... Read more
Reader Question:
Extravasation of Contrast Material
Question: We have doctors who use extravasation of contrast material as a diagnosis. I int... Read more
Reader Question:
ED Nurses
Question: I understand we should add all procedures that are currently on the physicians c... Read more
Reader Question:
Greater Tuberosity Fracture
Question: A patient presented to the emergency department (ED) with a fracture of the grea... Read more
You Be the Coder:
Proper Use of 10121
Question: When is it proper to use 10121? Can we use it only when the physician needs to p... Read more
Get Reimbursed When ED Services Overlap Other Departments
Because of the nature of its services, the emergency department (ED) rarely duplicates the... Read more
Understanding the New Rules Smooths APC Transition
Most hospitals are getting used to the idea of fee-schedule reimbursement for outpatient s... Read more
Case Study:
Receive Optimum Payment For Critical Care
The coding of critical care services presents a challenge for emergency department coders ... Read more
Reader Question:
Wound-care Supplies
Question: The nurses in our department are giving out wound care supplies to take home and... Read more
Reader Question:
Fractured Coccyx
Question: If someone comes in with a fractured coccyx, should we enter the specific proced... Read more
You Be the Coder:
Perineal Tumor
Test your coding knowledge. Determine how you would code this situation before looking at... Read more
Get Paid When EMS Personnel Perform Services in the Emergency Department
Every emergency department (ED) knows the story. Emergency medical technicians (EMTs) brin... Read more
ICD-9 Revisions Add Versatility To Billing and Reimbursement
With all the rush by emergency departments (ED) in hospitals to brace for ambulatory paym... Read more
Overcome the Challenges of Using -25 for ED Services
By Caral Edelberg, CPC, CCS-PPresident, Medical Management Resources Inc.Emergency departm... Read more
Reader Question:
Consultation vs. Prolonged Service
Question: The doctor is called into the hospital to dilate a trachea site, small tube alre... Read more
Reader Question:
Multiple Diagnoses and E Codes
Question: With multiple diagnoses and E codes, is the E code listed after the diagnosis it... Read more
Reader Question:
Clinical Sharp Debridements
Question: We are an outpatient wound care center in a hospital setting. Our physicians do ... Read more
You be the Coder:
Conscious Sedation
Test your coding knowledge. Determine how you would code this situation before looking at... Read more
Medical Decision-Making Is Key Factor in Determining Level of E/M Reimbursement
One could argue that every heart attack (410.9) that comes into the emergency department j... Read more
Get Paid for NP and PA Services
Emergency department (ED) coders must know the rules and regulations associated with nurse... Read more
HCFA to Release New Documentation Guidelines
As though managing the issues associated with ambulatory payment classifications (APC) wer... Read more
Reader Question:
Observation Care
Question: Is it necessary that a patient be located in a designated observation area to us... Read more
Reader Question:
Digital EEG Machine
Question: We have purchased a biologic digital electroencephalography (EEG) machine and ha... Read more
You Be the Coder:
Midlevel Providers
Question: We have a fast track/urgent care facility that is considered a clinic within the... Read more
Emergency Departments Will Reap Pay Up with Signs and Symptoms Coding
Nugget: Emergency departments will gain reimbursement for diagnostic services by coding si... Read more
HCFA Delays Launch of APC/OPPS to August 1
The Health Care Financing Administration (HCFA) has moved back the start date of the new O... Read more
Patient History Can Boost Level of Service
Nugget: ED physicians and staff should be encouraged to document history with: history o... Read more
APC Implementation Will Warrant Coding Compliance
Nugget: Hospitals will be required to identify all services provided to the patient during... Read more
Reader Questions:
Using Code 9058
Question: I have been running into problems with code 99058. Could you please tell me when... Read more
Reader Questions:
Billing Nurse Services Under APCs
Question: We would like to know if we will need to bill for nurses services separately und... Read more
You Be the Coder:
Coding Inpatient E/M
Question: When the ED physician is called to the floor to evaluate an inpatient and the vi... Read more
Correctly Appending Modifier -25 Can Be a Reimbursement Asset
Modifier -25 (significant, separately identifiable evaluation and management service by ... Read more
Clarify Services by Revising ED Assessment Criteria
By Caral L. Edelberg, CPC, CCS-PPresident, Medical Management Resources Inc.Consulting Edi... Read more
Clarifying Critical Care Creates Reimbursement Opportunities
A December 1999 program memorandum from the Health Care Financing Administration (HCFA) ma... Read more
Reader Question:
'Low/High' Decision-making
Question: Why is the medical decision-making level the same for 99283 and 99284?Cathee Hel... Read more
Reader Question:
Sepsis vs. Symptoms
Question: When coding to rule out sepsis on a pediatric emergency room (ER) visit, can we ... Read more
You Be the Coder:
CPR Coding
Question: When billing for CPR, does it matter who is actually performing it? Can we bill ... Read more
Correct Coding of Critical Care Optimizes Billing Of Second- and Third-Degree Burn Injuries
ED coders must rely on specific physician documentation of medical history, physical exa... Read more
Documentation Is Key to Getting Paid for Observation
When a patient presents to the emergency department (ED) with chest pain, the pain could b... Read more
Case Study:
Coding When Nonresponsive Cardiac Patient Dies in ER
A critically ill, unconscious patient brought into the emergency department (ED) provides ... Read more
Documentation of ED Encounter
EMS Prehospital Care Report Form: Call Received911/Dispatch; Aid Before ArrivalFirst Aid, ... Read more
Reader Question:
Using 99358 and 99359
Question: We are trying to find a code or codes to use for patients who are awaiting trans... Read more
Reader Question:
Laceration With Small Foreign Body
Question: When there is a simple laceration and a small foreign body is removed, should t... Read more
Detailed Documentation is Key to Wound Debridement Payment
When reporting debridementspartial thickness, full thickness, skin and subcutaneous tiss... Read more
Correct Coding is Crucial to Reimbursement for First- and Second-degree Thermal Burns
Coding for burn evaluation and treatment in the emergency department (ED) can be difficult... Read more
News Brief:
HCFA Clarifies Changes to Pulse Oximetry Monitoring
The Health Care Financing Administration (HCFA), the federal agency that oversees the Med... Read more
Reader Question:
Dislocation of the Patella
Question: A patient comes to the ED with a dislocation of the patella. He is given Dilaudi... Read more
Reader Question:
Documentation of the History of Present Illness
Question: I would like some written information about the documentation of the history of ... Read more
Avoid Denials by Coding Symptoms Supporting Medical Necessity of Flu Visits
Emergency departments (EDs) across the country have been overwhelmed in the last few month... Read more
Deciding Whether Use of ED Superbill Will Improve Billing
By Caral Edelberg, CPC, CCS-P, president ofMedical Management Solutions Inc. in Jacksonvil... Read more
Maintain Reimbursement for Critical Care Services
Emergency department (ED) physicians must provide careful documentation of the critical ... Read more
Reader Question:
Coding Medical Decision-making
Question: When determining the level of medical decision-making and considering the number... Read more
Reader Question:
Coding E/M Services
Question: When determining the level of medical decision-making of an evaluation and manag... Read more
Reader Question:
State Certification
Question: I would like to know about state testing for certification and whether there are... Read more
Avoid Denials by Not Using With Anesthesia Codes to Report Conscious Sedation
Correctly reporting the performance of conscious sedation in the emergency department (E... Read more
Use Modifier -26 to Correctly Code for Bronchospasm
Using modifier -26 (professional component) and documenting interpretation are key to opti... Read more
Case Study:
Appropriately Coding Unsuccessful Treatment
To correctly code for a patient who presents in the emergency department (ED), including ... Read more
Beware Proposed Screening Fees From Third-party Payers
Should your emergency department (ED) or emergency physician group accept set screening fe... Read more
Reader Question:
Billing Starred Procedure
Question: Is the exam of the affected area in a starred (*) procedure included in the proc... Read more
Reader Question:
Pulse Oximetry
Question: Is it acceptable for emergency physicians to bill for pulse oximetry interpretat... Read more
Correct Coding for Suture Placement and Removal in the ED Optimizes Reimbursement
When sutures are placed by the emergency department (ED) physician and removed by the pa... Read more
HCFA Establishes Unique Code for Dermabond Use
For months, coders debated the pros and cons of coding wound repair using the tissue adhes... Read more
Correctly Coding ED Services and Procedures Avoids COBRA Violations
In addition to choosing the codes to correctly report emergency department (ED) services ... Read more
Written Report Reduces Denials of Rhythm Strip Interpretations
In the December 1999 issue of ED Coding Alert (page 89-91), we detailed correct coding and... Read more
Clarification:
Evaluation of Patient With Hip Injury Complicated by Hypertension Might be Higher than Level 4 E/M
In the October 1999 ED Coding Alert, the article E/M Coding Clinic: Correctly Reporting 99... Read more
Reader Question:
Nail Bed Repair
Question: I would appreciate a discussion on nails as covered in the Integumentary system ... Read more
Available Years:  2000  1999  1998