ED Coding and Reimbursement Alert

CPT® 2012 Update:
Prepare For These Key Changes in Observation and Prolonged Services Codes
And check out new guidance on wound, burn and ultrasound services that could affect your r... Read more
CCI Edits 101:
Avoid Compliance Conundrums: Apply CCI Edits Correctly With This Primer
Review these tips to fully understand how CCI impacts your code selection.Write a simple c... Read more
Reviewing Edit Information on CMS:
A Few Pointers
Check these time saving tips on using the CMS site for reviewing edits.Where to look: The ... Read more
Reader Question:
Consult Code Book For Foreign Body Removals From the Foot.
Question: A patient with a splinter reported to the ED. After a level-two E/M, the physici... Read more
Reader Question:
Be specific with the diagnosis to show ECG Claim medical necessity
Question: What codes should we use to report diagnostic electrocardiography (ECG) tests? A... Read more
Reader Question:
Use Correct Time Threshold For Moderate Sedation
Question: In our ED group, our moderate sedations are usually less than 16 minutes. The CP... Read more
You Be the Coder:
What are the rules for physical presence in a teaching setting?
Question: We are getting a lot of feedback that our emergency physician faculty members, w... Read more
Diagnostic Interpretations:
Finesse Your EKG Interpretation Claims With This Can't Miss Documentation Advice
Does your chart include the required elements to stand up under audit? If you're getting ... Read more
What Does Separately Identifiable Mean? Heed Medicare's Advice on What Constitutes a Written Report
Medicare states that the EKG interpretative report must be a complete written report simil... Read more
Ultrasound Coding:
Probe Carefully to Ethically Maximize Ultrasound Reimbursement
Diagnostic imaging services are under increased payer scrutiny. Learn these tips to make s... Read more
Common ED Ultrasound Codes
76536 Ultrasound, soft tissues of head and neck (e.g., thyroid, parathyroid, parotid), re... Read more
Influenza Vaccine Coding:
Look Sharp at New Vaccine Codes For The 2011 Flu Season
Double check your code assignments to make sure you comply with payer instructions. Flu se... Read more
Reader Question:
Solve Nasal FBR Coding Dilemma
Question: I'm a bit confused. When reporting a foreign body removal of the nose, wou... Read more
Reader Question:
Can Pre-Hospital Direction To EMS Be Included In Critical Care Time?
Question: Can you count the time a physician is involved in \"pre hospital care\" in crit... Read more
Reader Question:
(Nearly) Dead Men Tell No Tales: Apply History Exemption Caveat for Critical Care
Question: If a patient comes to the ED in critical condition and is not able to give a hi... Read more
Reader Question:
In The Midnight Hour: How To Report An ED Visit That Transcends The Calendar Date
Question: On what day do I report an ED visit when the patient arrives and physician trea... Read more
You Be the Coder:
Nail Down the Correct Code For This Finger Injury
Question: What codes would your assign for the following chart note: Wound Repair of 1cm ... Read more
ICD-9 Update:
Adjust Your 2012 Dx Coding for Dementia, Influenza, and Anaphylactic Reactions
Consider these new diagnosis codes to best capture your ED services. Although everyone is ... Read more
E/M Coding:
Is There a Doctor in the House? Take This Primer on Reporting "In-house" Services
4 tips help you select the right code to describe services provided outside the emergency ... Read more
Typical Floor Service Procedures:
Typical Floor Service Procedures:
Intubation: 31500 (Intubation, endotracheal, emergency procedure)Central Line: 36556 (Inse... Read more
Behavior Modification Codes:
Calling for an Intervention: Get a Grip on Your Behavior Modification Services Coding
Analyze the coding and reimbursement environment before assigning codes for smoking or sub... Read more
Reader Question:
Listen Carefully For How To Report Ear Blockage Removal
Question: Is irrigation of the ear canal included in the E/M or a separately billable proc... Read more
Reader Question:
External Vs. Internal Abscess Will Determine I&D Code Choice
Question: Can anyone tell me the correct CPT® code for an I & D of a knee absces... Read more
Reader Question:
Assign Physical exam Organ System By Statement Context
Question: Using 1995 guidelines, in which organ system would this fall for a PE element? "... Read more
You Be the Coder:
Wound Repair Qualifies for Subsequent Hospital Care
Question: An emergency physician is called to the inpatient setting by a floor nurse to ca... Read more
Intubation Coding:
Go With the Flow: 5 Tips Boost Your Common ED Airway Procedure Accuracy
Seconds count with airway tube insertions, but take a few minutes to learn these important... Read more
Laceration Repairs:
Wound Repairs of the Lips and Mouth: Have Your Papers in Order Before Crossing the Vermillion Border
Understand the anatomical differences in the mouth repair codes to ethically maximize your... Read more
E/M Coding:
Capture Prolonged Service Encounters in the ED With These Tactics
Tip: Read the fine print before assigning code 99354.A frequent question among emergency d... Read more
Reader Question:
Not Every Pain in the Rear is a Pilonidal Cyst
Question: Can you help me with CPT® code assignment for this procedure? The chart no... Read more
Reader Question:
Select Code By Freestanding ED vs. Urgent Care Designation
Question: Our group just started staffing a free standing ED. What place of service should... Read more
Reader Question:
Identify Acute or Obstructive For COPD With Bronchitis
Question: Can someone tell me what diagnosis code would be appropriate for COPD with bronc... Read more
You Be the Coder:
Look within before assigning a penetrating trauma code
Question: A patient presents to the emergency department after he cut the tip of his finge... Read more
Coding Strategies:
Make Sure Your Wound Recheck Policy is All Sewn Up for Accurate Coding
Medicare changes to the simple repair codes will cost you money, unless you know these tip... Read more
Coding Tools:
Sample ED Relevant 2011 CPT® Codes with Reduced Global Surgical Package Days
Keep this chart handy to help you master the 2011 global changes to some frequently-used c... Read more
Audit Tips:
Are Your Frequency Distribution Comparisons "Apples to Apples"? Avoid Outlier Designation With This Crucial Advice
Use these tips to defend your distribution.Payer expectations for a normal ED distribution... Read more
Reader Question:
Stay Alert to the Degree of Anesthesia Used with Orthopedic Procedures
Question: Would 23655 be the appropriate code for closed reduction of shoulder dislocation... Read more
Reader Question:
Don't Be "Blocking the Digits" with Repair Codes
Question: If a physician performs a digital block on a finger and repairs a 2 cm laceratio... Read more
Reader Question:
What's the Buzz on Ultrasound Documentation Requirements?
Question: Can you tell us if many ED groups are successfully coding and billing for ultras... Read more
You Be the Coder:
Stick to the Right Code for Tissue Adhesives
Question: A 77 year old patient presented after having suffered a fall from the back porch... Read more
Tube Replacement:
Nail Correct Codes for Tube Procedures With This E/M Advice
If you code 43760 for all tube replacements, you're playing with fire.A patient presents t... Read more
E/M Coding:
Code Correctly by Heeding HPI Rules on High-Level E/Ms
Prove extended HPI or settle for 99281, through 99283.If you don't recognize the differenc... Read more
Documentation:
Prove Service's Separate Nature Before Coding E/M-25
Modifier 25 used most often on separate ED E/Ms.When your ED physician performs a procedur... Read more
Reader Question:
Code Vent Management If Physician Completes Procedure
Question: A 65-year-old inpatient in the hospital's intensive care unit (ICU) goes into ac... Read more
Reader Question:
Use E Codes to Paint Patient Picture
Question: A patient reports to the ED complaining of pain in his arm, lower back and chest... Read more
Reader Question:
Up I&D Level When Packing Gets 'Extensive'
Question: A patient presents to the ED with a swollen growth on her left thigh; she report... Read more
Reader Question:
Consider Malignancy Status When Choosing Excision Code
Question: A patient presents to the ED with several lesions on his upper body. The physici... Read more
You Be the Coder:
Choosing Codes on Complex Scenarios
Question: A 36 year old patient presents to the ED with pain and inability to ambulate due... Read more
Critical Care Coding:
Are You Overlooking CC For Your ED Caveat Patients?
Tip: CC codes carry no caveat constrictions.When you spot an encounter form that's a candi... Read more
Closures:
Check More Than Layers to Arrive At Correct Closure Level
Dig deeper into notes to get a grip on repair levels.ED coders cannot consider all closure... Read more
Documentation:
Get Providers to Sign Each Time, Ensure All Claims
Answers to 2 common signature questions help ensure you're on track.Including provider sig... Read more
Reader Questions:
Max Out Payoff By Remembering All FAST Exam Components
Question: A driver who was in a motor vehicle collision (MVC) arrives at the ED via ambula... Read more
Reader Questions:
Check the Clock Before Coding Critical Care
Question: A patient reports to the ED with shortness of breath and requires intubation to ... Read more
Reader Questions:
Leave Dental Codes Off Your ED Claim
Question: I have a puzzling claim in front of me. Notes indicate a patient reports to the ... Read more
Reader Questions:
Choose Most Severe Burn for ICD-9 Coding
Question: A patient reports to the ED with first- and second-degree burns to his abdominal... Read more
You Be the Coder:
Mind Ligation Bundles On Repair Claims
Question: A patient presents to the ED with a persistent dialysis fistula bleed. Physician... Read more
E/M coding:
Salvage Your 99285 Claims With This Can't-Miss Caveat
Beware: This ED exception has strict documentation requirements.A patient reports to the E... Read more
Laceration repairs:
Know Encounter Specifics to Get Your Cut for Each Laceration Repair Claim
Evidence of debridement often leads to intermediate fix code.The ability to tell the diffe... Read more
CCI 17.1 Edits:
Avoid Coding ECG With CPR
CCI also wraps up E/M, counseling codes.The correct coding initiative (CCI) version 17.1 a... Read more
Reader Questions:
Roll Rabies Vaccination into E/M
Question: A patient presents to the ED with a dog bite on his left abdominal wall, near th... Read more
Reader Questions:
Leave Pediatric Codes Off Your CC Claim
Question:A father brings his 6-year-old child to the ED; according to encounter notes, the... Read more
Reader Questions:
Spot Extended HPI for Higher-Level E/Ms
Question:A teenager presents with intermittent right sided abdominal pain occurring at lea... Read more
You Be the Coder:
Modifiers and Your Fracture Care Claims
Question:A 4-year-old girl reports to the ED with her mother; the mother says the child sl... Read more
E/M coding:
Note Code Changes for Spot-On ED Observation Reporting
Careful: New 'middle day' codes could complicate your claims.There's something old and som... Read more
Procedure coding:
Mark Revenue-Boosting Cerumen Removal-E/M Encounters, Double Your Money
E/M-25 practically a given on earwax removal encounters.If you're keen to the guidelines g... Read more
Observation coding:
Observation Under 8 Hours? Consider This Coding Strategy
Remember to leave 99217 off these claims.Observation coding conventions call for a code fr... Read more
Reader Questions:
Leave Pulse Ox Code Off ED Claims
Question: A patient with a diagnosed history of sleep apnea reports to the ED complaining ... Read more
Reader Questions:
Get Specific When Reviewing X-Ray Info
Question: A woman who fell on her unprotected side reports to the ED. The physician notes ... Read more
Reader Questions:
Assuming I&D Occurred Is Dangerous Coding
Question: A patient reports to the ED with a blister on her right finger. During an expand... Read more
You Be the Coder:
Comforting Dying Patient Is Not Critical Care
Question: A patient becomes unresponsive in the ED and the physician begins critical care.... Read more
Nosebleed Repairs:
Know Instrumentation & Methods for Smart Nosebleed Repair Coding
Here's why coding 30901 for ice stoppage might not be proper.A patient reports to the ED w... Read more
ICD-9/ICD-10
ICD-10 implementation is coming in 2013 and it's not too early to learn what those changes... Read more
Modifier Use:
2 Nostrils? Call on Modifier 50
Here's why you shouldn't code 30901 x 2.If your ED physician happens to perform anterior n... Read more
NPP Coding:
Get Physician's Face Time On Record to Ensure Shared Coding Success
Medicare will let the duo 'team up' to provide certain services.ED coders that don't recog... Read more
Reader Questions:
Code Splinting Only In Certain Situations
Question: A 3-year-old child presented to our ED with a history of falling off a chair and... Read more
Reader Questions:
Use Modifier 54 Only When Follow-Up Is Certain
Question: A 17-year-old patient presents to the ED with a laceration on his 4 cm scalp He ... Read more
Reader Questions:
Provide Proper Documentation to Make ROS Rock-Solid
Question: Encounter notes indicate a patient presented to the ED following a collapse and ... Read more
You Be the Coder:
Coding 'Needle to Chest' Procedures
Question: A patient reports to the ED via ambulance. The emergency medical technician (EMT... Read more
ED E/M Coding:
Use 94002, 94003 Sparingly: Opt for E/M on Most ED Vent Services
Here's why your physician will rarely provide 94002, 94003 solely.If your physician provid... Read more
Diagnosis Coding:
Follow These 4 Steps to Master 940-949 Burn Diagnoses
Proper ICD-9 coding for burn patients can require several codes.ED coders who cannot choos... Read more
News you can use:
EDs Get a Break on E/Ms As Congress Passes Pay Fix
New legislation tables 25 percent drop in 2011 Medicare pay.ED practices won't face the sa... Read more
Reader Question:
Mind New CPT Sets for US Service
Question: I have a denial in front of me that is quite puzzling. Our ED physician performe... Read more
Reader Question:
Remember Documentation When Applying Caveat
Question: An apparently homeless patient presents to the ED via ambulance unresponsive wit... Read more
Reader Question:
NOS Codes Salve Unknown Skin Rash Dx Issues
Question: A patient recently reported to the ED with a rash on his chest and abdominal are... Read more
Reader Question:
HPI Level Only Paints Part of E/M Picture
Question: A 50-year-old female patient reports to the ED complaining of severe abdominal p... Read more
You Be the Coder:
KO Sedation Questions by Checking for CPT Signs
Question: A 44-year-old patient reports to the ED with an injured left shoulder; a level-f... Read more
Available Years:  2011  2010  2009  2008  2007  2006  2005  2004  2003  2002  2001  2000  1999  1998