ED Coding and Reimbursement Alert

ED Coding And Reimbursement Alert - 2007: Volume 10, Number 12

Distinguish Complicated I&D Documentation From Simple to Boost Pay
Focus on complexity to choose between 10060 and 10061 If you can differentiate betwee... Read more

Medicare Approves Paying for More Moderate (Conscious) Sedation Scenarios
But sedation codes still have Medicare -C- status There is good news for ED coders: M... Read more

Reader Question:
Include 948.xx for Your Burn Patients
Question: I have been coding for a few months, but I still get stumped on burn diagnos... Read more

Reader Question:
Report Dx Code for Each Decubitus Ulcer
Question: A patient reports to the ED with decubitus ulcers on her right heel and left... Read more

Reader Question:
Look for Nerve Block on Trigeminal Neuralgia Encounters
Question: A patient reports to the ED reporting severe pain on the right side of her fac... Read more

Reader Question:
3-Plus Trigger Point Shots Alter Code Choice
Question: A patient suffers whiplash from crashing his car into a parked vehicle, and ... Read more

Reader Question:
You Can Report V Codes As Primary -- Sometimes
Question: Please straighten something out for me. I have heard again and again that I ... Read more

Reader Question:
Adverse-Reaction Pay Depends on Insurer
Question: The ED physician performs simple repair on a 4.6-cm laceration on a patient'... Read more

Reader Question:
Be Alert When Assigning Consciousness Codes
Question: The ED physician saw a patient and documented the reason for the visit as -E... Read more

Reader Question:
Remember ICD-9 Code on Bladder Scan Claim
Question: A patient presented complaining of pain during urination. The physician perf... Read more

Reader Question:
Observe Differences in CMS, CPT Consult Criteria
Question: It is my understanding that if a requesting physician asks for an opinion about ... Read more

You Be the Coder:
Coding When ED Physician Calls on Specialist
Question: A patient presents with a badly injured left ankle. During the course of a lev... Read more

ED Coding And Reimbursement Alert - 2007; Volume 10, Number 11

Count on More Than Depth to Justify Wound Repair Level
Some deep cuts require only simple closureLaceration repair coding can get difficult fast:... Read more

Clip and Save:
Acronym Ensures Proper Wound Repair Documentation
LLLDTEAR lights the way for codersSo you-ve mastered the ins and outs of CPT coding for la... Read more

Inherent or Separate? You Must Know Before Coding E/Ms With Modifier 25
Be ready to scour notes for proof of separate E/MAll medical coders need to know the rules... Read more

READER QUESTIONS:
Use This Primer as Your FAST Exam Template
Question: What is a FAST exam, and how should coders report the procedure? I overheard a f... Read more

READER QUESTIONS:
Mind Coding Conventions for Observations
Question: At 11 a.m. Wednesday, a patient reports to the ED complaining of lower back pain... Read more

READER QUESTIONS:
Report Single Code for Drainage/Joint Injection
Question: A patient reports to the ED after falling from a ladder. She is complaining of p... Read more

READER QUESTIONS:
Observe CCI Bundle on Burn/Debridement Claims
Question: A patient reports to the ED with a partial-thickness burn on his face. Encounter... Read more

READER QUESTIONS:
Diagnostic Decision Should Figure Into E/M Level
Question: A patient reports with a severe headache and blurred vision. During the course o... Read more

READER QUESTIONS:
Mother's Milk Making Baby Sick? Check Drug Reaction Codes
Question: A mother who is taking Flexeril brings her 1-month-old child into the ED. The pa... Read more

READER QUESTIONS:
If Physician Specifies Cause, Consult Organic Apnea Codes
Question: What is organic sleep apnea? My physician has been using 780.57 to report sleep ... Read more

You Be the Coder:
ICD-9 Coding for Burns in the Same Region
Question: A patient reports to the ED with a pair of burns: a second-degree burn on her ri... Read more

ED Coding And Reimbursement Alert - 2007; Volume 10, Number 10

Check Methods, Attempts Before Coding Nosebleed Encounters
Certain methods may signal a more complex treatmentWhen your ED physician treats a patient... Read more

Here Are the PQRI Ropes for EDs That Want to Participate
PQRI requires you to report quality measures, whether or not your doctor met themEDs that ... Read more

Physicians May Meet Quality Measures but Lack Proof
Successful practices offer these tips to preparing for PQRIED coders are gearing up to par... Read more

READER QUESTIONS:
Complete ROS Requires Double-Digit Reviews
Question: I have a question about the review of systems (ROS) portion of E/M services. Wha... Read more

READER QUESTIONS:
Check for E/M on Esophageal FBR Claims
Question: A frantic parent brought a child into the ED after the child swallowed a foreign... Read more

READER QUESTIONS:
Know the Difference Between Medial, Lateral Meniscus Tears
Question: A patient reports to the ED complaining of pain and swelling in her right knee. ... Read more

READER QUESTIONS:
Use Tool Kit for Optimal PQRI Reporting
Question: My ED doctors have put me in charge of setting up a Physician Quality Reporting ... Read more

READER QUESTIONS:
Heart Failure Diagnosis Trumps Other Symptoms
Question: What are some signs and symptoms that a patient might have had heart failure?Ken... Read more

READER QUESTIONS:
Zoom in on Supervision Requirements
Question: If an NP or PA were to perform a diagnostic test, as long as it was within his s... Read more

You Be the Coder:
Measuring Lesion Excision Sites
Question: When the ED physician removes a benign lesion, how should I measure the excision... Read more

ED Coding And Reimbursement Alert - 2007; Volume 10, Number 9

Materials Make a Difference When Choosing a Splinting, Strapping Code
Plaster, fiberglass typically indicate splint use When a patient needing a splint or ... Read more

Bandages May Not Be Aces With Payers
Expert: Check policies before coding ACE bandages as straps While you may look at an ... Read more

Check for Guidance, Monitoring on G Tube Claims
You-ll be missing $$$ if you don't code for radiologic guidance when possible Patient... Read more

Reader Questions:
Most ED Aneurysms Are Aortic
Question: I have been coding in an ED for a few months and have not had experience in co... Read more

Reader Questions:
Use This Guidance for After-Hours Codes
Question: What's the deal with ED physicians getting paid for 99053? I know Medicare doe... Read more

Reader Questions:
'Blanket' Policy May Smother Critical Care Pay
Question: Our compliance department is pressuring the ED coders to simplify critical car... Read more

Reader Questions:
Physicians Treat Pleural Effusions 3 Different Ways
Question: I heard one of my co-coders talk about a patient suffering a pleural effusion ... Read more

Reader Questions:
Deduce Angina Type Before Coding
Question: What exactly is "angina pectoris" and what is the proper diagnosis code for th... Read more

Reader Questions:
Choose Reduction Code After Answering Anesthesia Question
Question: A man with a severely swollen left elbow reports to the ED. During a level-thr... Read more

Reader Questions:
Physician Involvement Drives Blood Draw Coding
Question: Our physician ordered an arterial blood draw, which the hospital staff perform... Read more

You Be the Coder:
You Might Not Need Hypoglycemia Code if Patient Has Diabetes
Question: A patient with type I diabetes mellitus participates in strenuous activity and... Read more

ED Coding And Reimbursement Alert - 2007; Volume 10, Number 8

Is Your Coding Leaving Critical Care Dollars on the Table?
Expert reveals the audit technique that leads you to the extra cash Heads up, ED coders. ... Read more

Check the Clock on Multiple-Substance Infusions
... Read more

Clip & Save ~ Keep These Common Medical Terms Handy
Knowledge of terms can make coding less confusing Every medical coder realizes the import... Read more

Reader Question ~ Anatomy Guide an Indispensable Coding Resource
Question: I am new to ED coding, and I was wondering what types of resources I should keep... Read more

Reader Question ~ Wait for Test Results Before Settling on Dx
Question: A patient reports to the ED complaining of wheezing and breathlessness. The phys... Read more

Reader Question ~ 'Comminuted' Typically Means Closed Fracture
Question: What exactly is an open fracture? We are having a debate in the coding office. O... Read more

Reader Question ~ Exam Must Exceed 'Incidental' for Extra E/M
Question: A patient with gamekeeper's thumb reports to the ED. The operative notes indicat... Read more

Reader Question ~ Unbundle Biopsy, Destruction With Modifier 59
Question: A patient reports to the ED with three plantar warts on his right foot and a les... Read more

Reader Question ~ Size Matters on Devitalized Tissue Removal Code
Question: A patient with a pressure ulcer on his shoulder blades reported to the ED, and t... Read more

Reader Question ~ Choose Code Based on Symptoms if Doctor Doesn't Diagnose Depression
Question: When a patient exhibits signs of depression, but the physician does not diagnose... Read more

You Be the Coder ~ Coding for Burns in the ED
Question: What constitutes a first-, second- or third-degree burn? I am having trouble fig... Read more

ED Coding And Reimbursement Alert - 2007; Volume 10, Number 7

Check for Incision Before Reporting Soft-Tissue FBR
Eye, soft-tissue FBRs have different code sets With those carefree summer days fast appro... Read more

Grab More Reimbursement for Some FBRs
Look for these op note details to spot a complicated soft-tissue FBRWhile patients typical... Read more

News You Can Use:
New Cardiac Arrest V Codes Coming in Latest ICD-9
Look for final list in early JuneIn the fall, ED coders will have some new ICD-9 codes to ... Read more

Acute Conditions Essential to Correct COPD ICD-9 Coding
Status asthmaticus diagnosis trumps any COPD the patient may haveWhen a patient presents t... Read more

Keywords Can Guide You to Correct COPD Diagnosis
Here's how to educate your doctors for better ICD-9 codingPhysicians base an initial diagn... Read more

READER QUESTIONS:
Chronic Pain Syndrome Diagnosis May Not Be Specific Enough
Question: What is the best diagnosis code for chronic pain syndrome?Indiana Subscriber An... Read more

READER QUESTIONS:
Think Twice Before Coding Death Pronouncement
Question: When the hospital asks an ED physician to pronounce a patient's death, what code... Read more

READER QUESTIONS:
Check With Payer for Preferred FB Sensation Diagnosis Code
Question: I need some ICD-9 help for this claim. A patient reports to the ED complaining o... Read more

READER QUESTIONS:
Separte Documentation Keys Modifier 25 Coding
Question: I am having trouble with my modifier 25 coding, specifically with my documentati... Read more

READER QUESTIONS:
Single ICD-9 Code Represents Syncope and Collapse
Question: A patient who suffered a syncope and fall reports to the ED. The patient is also... Read more

You Be the Coder:
Mind Your Modifiers on E/Ms During Global Periods
Question: The ED physician performs incision and drainage on a patient's forearm carbuncle... Read more

ED Coding And Reimbursement Alert - 2007; Volume 10, Number 6

Use These Tips to Master Dual-Code Challenge of FAST Exam
Most FAST exam claims also need modifier 26 Patients who report to the ED with abdo... Read more

No Fooling:
New NCCI Bundles Burn and Debridement Codes
The edits, which took effect April 1, also tighten up vaccine coding The latest version o... Read more

Rely On Physician's Notes When Selecting Dx Codes
Often, knowing where to look can provide all the info for proper coding Incomplete docume... Read more

Reader Questions:
If Same Problem Prompts Both, Report Same Diagnosis for E/M, Procedure
Question: Our ED physician treated a patient with a pressure ulcer on the back of her head... Read more

Reader Questions:
Code Post-MVA E/M Based on Physician Actions
Question: A mother reports to the ED with her 6-day-old son after a moderate motor vehicle... Read more

Reader Questions:
Remember Dx Code on Your Nursemaid Elbow Treatment Claims
Question: Our ED physician treated a 3-year-old patient for nursemaid elbow. What procedur... Read more

Reader Questions:
Answer Spica/Standard Splint Question Before Choosing Code
Question: A patient with a closed fracture of the thumb base reports to the ED. The ED phy... Read more

Reader Questions:
Report V Codes for Patient's Long-Term Meds
Question: A patient reported to the ED due to effects from long-term current use of aspiri... Read more

You Be the Coder:
Coding Multiple-Laceration Scenarios
Question: A patient reports to the ED with facial cuts. The physician performs a simple 2.... Read more

ED Coding And Reimbursement Alert - 2007; Volume 10, Number 5

Choose Observation Code Based on Length of Patient Stay
Learn to ID observations, which pay about 60 percent more than E/MsWhen your ED phys... Read more

4 Questions to Ask Before Filing Critical Care Claim
Do you know what services are bundled into 99291, 992927Coding for critically ill patients... Read more

Submit Separate Reports for Critical Care and E/M Claims
What you need to know about a little-known, correct coding strategyAlthough critical care ... Read more

READER QUESTIONS:
In the ED, Physicians Usually Perform Closed Treatment
Question: What is the difference between an open and closed fracture treatment?California ... Read more

READER QUESTIONS:
Don't Report Bandage Wrap as Strapping Unless Payer Allows It
Question: A patient reports with a swollen right ring finger. The physician performed an x... Read more

READER QUESTIONS:
Clear Up Filing Deadline Issues With Chart
Question: Our ED keeps getting denials because we are missing timely filing deadlines. How... Read more

READER QUESTIONS:
Choose Single ICD-9 Code to Represent Aortic/Mitral Value Condition
Question: Our ED physician conducted a 12-lead electrocardiogram (EKG) on a patient diagno... Read more

You Be the Coder:
Choosing Between Simple, Complicated FBR Codes
Question: A patient presents complaining of arm and finger pain, contusions to her upper a... Read more

ED Coding And Reimbursement Alert - 2007; Volume 10, Number 4

Maximize Multi-Code Claim Revenue With Modifiers 59, 51
Remember to attach modifier 51 to lower-valued codeED physicians often have to perform mor... Read more

On Excision Claims, Measure Lesion Size Before Pathologist Sees It
Pathology procedures will shrink lesion and your ED's reimbursementWhen patients with lesi... Read more

Report Intermediate, Complex Closures Separately on Excision Claims
When closure gets more complicated, 2-code claim possible If your ED physician perfor... Read more

Reader Question:
Repair Bundled into Wound Exploration
Question: A patient with a penetrating wound on his upper thigh came into the ED. He was i... Read more

Reader Question:
Follow 'Rule Of Nines' For Burn Diagnosis Coding
Question: I have not been coding in the ED very long, and I have a question about burn dia... Read more

Reader Question:
Reporting G Tube Code For J Tube Replacement Could Be A Mistake
Question: A patient reported for replacement of a jejunostomy tube (J tube). I-ve never co... Read more

Reader Question:
Treat Foot FBRs Differently Than Soft-Tissue FBRs
Question: Our physician performed simple foreign body removal (FBR) on a patient with a wo... Read more

Reader Question:
E/M Possible On Hydration Encounter
Question: A patient who is complaining of diarrhea and extreme thirst reports to the ED. S... Read more

Reader Question:
Check for Radiologic Guidance, Then Code for G Tube Placement
Question: A patient comes to the ED with a displaced gastrostomy tube (G tube). The physic... Read more

You Be The Coder:
Is E/M and Repair Possible on Laceration Claim?
Question: A construction worker who was using a table saw reports to the ED with lacerated... Read more

ED Coding And Reimbursement Alert - 2007; Volume 10, Number 3

Think All Cerumen Removal Claims Are Equal? Think Again
E/M code is the better option when cerumen isn't impacted If an ED physician removes ceru... Read more

Add an E/M Service to Most 69210 Claims
Report cerumen removal with E/M if you can prove the services are separate Patients w... Read more

When You See a 'Targeted' Code, Think Twice Before Reporting Moderate Sedation
Good news: Some insurers are now reimbursing sedation codes, experts say When your ED phy... Read more

READER QUESTION ~ Check Procedure's Global Period Before Reporting an E/M Service
Question: A Medicare patient reports to the ED for drainage of a simple finger abscess. Th... Read more

READER QUESTION ~ ECGs in ED Call for 'Interpretation and Report Only' Code
Question: Our ED physician performed an electrocardiogram (ECG) on a patient complaining o... Read more

READER QUESTION ~ Disregard Age When You Choose an Intraosseous IV Code
Question: The operative report indicates that the physician performed a level-five evaluat... Read more

READER QUESTION ~ Use This Diagnosis for Asthma With Croup
Question: A patient with a history of asthma who is now taking Albuterol reports to the ED... Read more

READER QUESTION ~ Don't Report a Separate Code for Ear Wick Insert
Question: One of our physicians inserted an ear wick saturated with an antibiotic into a p... Read more

YOU BE THE CODER ~ Hydration With End-of-Session Flush
Question: A patient complaining of vomiting and stomach pain presents to the ED. The physi... Read more

ED Coding And Reimbursement Alert - 2007; Volume 10, Number 1

Don't Change How You Report ROS to Medicare Payers
WPS Medicare changes ROS documentation requirement, only to reverse its decision The end ... Read more

Observe 10-System Minimum for Complete ROS
ROS level helps to determine E/M level on your claims When your physician performs an eva... Read more

NEWS YOU CAN USE ~ Congress Stalls 2007 Medicare Pay Cut
Scheduled 5.1 percent decrease scrapped at the last minute On its way out the door, t... Read more

Report Burn Location Diagnosis to at Least the Fourth Digit
Don't forget to include a code from the 948 series, too When a patient reports to the ED ... Read more

Take 5 Steps for Proper Coding of Wound Repair
Medicare has a special requirement for tissue adhesive Several variables govern coding fo... Read more

Study 5 Cases to Learn Foreign-Body Removal
The physician must decide if the procedure is simple or complicated Appropriate reporting... Read more

READER QUESTION ~ Check for Slit Lamp Use on Corneal FBR Claims
Question: A patient with a foreign body in her left eye presents to the ED for treatment. ... Read more

READER QUESTION ~ Report 1 Code for Pressure Ulcer Treatment
Question: A patient came to the ED for treatment of a pressure ulcer on her lower back. Th... Read more

READER QUESTION ~ Be Wary of Suspect Injury Explanations
Question: A 6-year-old girl with a black eye reported to the ED. The physician's notes ref... Read more

YOU BE THE CODER ~ Chronic Conditions in the ED
Question: A patient with type II diabetes reported to the ED complaining of a severe heada... Read more

Available Years: 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998