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ED Coding and Reimbursement Alert
ED Coding and Reimbursement Alert
ED Coding And Reimbursement Alert - 2018; Volume 21, Number 12
ED Payment:
Study: If Other Payers Adopt Anthem's Policy, ED Denials Will Skyrocket
New analysis takes new look at Anthem's controversial program. Wondering how rampant Anth...
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ICD-10:
Are You Reporting Hypertension Correctly?
Oct. 1 is behind us – make sure you've implemented these updates. ED coders are well aw...
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Procedure Coding:
Performing Incision and Drainage? Know the Treatment Depth
Plus: Find out how to differentiate between simple and complicated. When patients present...
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Reader Question:
What to Do When You Send Records Too Late
Question: We have a few claims under medical review, and when we went to send the backup d...
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Reader Question:
CPT®, ICD-10 Codes Will Depart LCDs
Question: We recently learned that CMS is instructing the MACs to change the local coverag...
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Reader Question:
Differentiate Workers' Comp, Medicare Claims
Question: A 66-year-old patient presented to the ED after falling off a loading dock at a ...
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Reader Question:
Nail Down Diagnosis for Calcified Ureteral Stent
Question: A patient presented to our ED with groin pain and the ED physician diagnosed him...
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You Be the Coder:
Chronic Bronchitis Can Be Difficult to Code
Question: We had a patient come in with bronchitis and the physician didn't specify the ty...
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ED Coding And Reimbursement Alert - 2018; Volume 21, Number 11
CPT® 2019:
Prep Now for Big Changes to PICC Line, FNA Codes Effective Jan. 1
Break out the red pen and prepare for a code overhaul. Sometimes it feels like we just tu...
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Medicare Documentation:
5 Tips Help You Meet Medicare's Signature Requirements
Hint: You can send signature logs, attestations routinely without repercussions. You pore...
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Modifiers:
Seeing Patients Following A Disaster? You May Need Modifier CR
Cover your post-disaster coding and billing with these quick tips. We're still in the mid...
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Reader Question:
Get the Scoop on this Fracture Dx
Question: I have a claim in front of me that is completely bewildering. Notes indicate tha...
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Reader Question:
How Important Are Finger/Toe Modifiers?
Question: We had a private consulting firm audit our records recently, and they determined...
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Reader Question:
Should Our ED Be on Social Media?
Question: We attended a presentation by a health care marketing organization who said we s...
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You Be the Coder:
Can You Code This Abdominal Pain Scenario?
Question: A 25-year-old man presented to the ED with abdominal pain. The physician noted c...
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ED Coding And Reimbursement Alert - 2018; Volume 21, Number 10
Compliance:
OIG Begins Reviewing Critical Care Claims via Work Plan
Auditors will soon start scrutinizing claims for critical care services. If you've ...
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Part B Stats:
Medicare Reviewers Reveal Issues They Found With Critical Care Claims
The results of this comparative billing report may surprise you. If our cover story makes...
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Consider An Internal Audit to Check Your Critical Care Processes
Many MACs are already reviewing these claims. If you're worried about your critical care ...
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Clip And Save:
Don't Forget The Services That Are Bundled into 99291 and +99292
The CPT® critical care preamble includes a specific list of services that are bundled in ...
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Reader Question:
Nail Down Pediatric CC Rules
Question: Our ED physician saw a critically ill pediatric patient yesterday but has never ...
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Reader Question:
CPR, Critical Care Can Be Reported Together
Question: A patient went into cardiac arrest in our ED waiting room. The physician perform...
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Reader Question:
Follow These Tips for Self-Audit Success
Question: We're interested in performing a self-audit of our critical care claims but we'v...
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You Be the Coder:
Document Time Carefully With Multiple Physicians
Question: When two physicians of the same specialty and group practice provide critical ca...
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ED Coding And Reimbursement Alert - 2018; Volume 21, Number 9
Part B Payment:
See How the Proposed 2019 Fee Schedule Could Impact Your ED
CMS proposes vast changes, but EDs are spared from the biggest impact. If you've heard th...
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Part B Payment:
Check These Proposed Changes to Quality Measures
Plus: What's the proposed conversion factor for 2019? The proposed physician fee schedule...
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Bleeding Control:
Can You Answer These Bleeding Control FAQs?
From Minnesota tube to epistaxis control, test yourself on these scenarios. Emergency dep...
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Reader Question:
Know What Constitutes Primary Dx
Question: We saw a patient who presented for a COPD exacerbation and he went into acute re...
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Reader Question:
Know What Constitutes A Business Associate
Question: We recently hired a cloud storage outsourcing company for our medical records, a...
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Reader Question:
Combo Dx Deserves Two Codes
Question: What is the correct way to code for type 2 diabetes and a urinary tract infectio...
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Reader Question:
Keep Sequencing in Mind When Patient Has HIV
Question: The ED physician saw an HIV-positive patient for treatment of numerous chronic m...
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Reader Question:
Age Can Drive Venipuncture Codes
Question: I know that age is one of the factors that differentiates between the venipunctu...
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You Be the Coder:
Look to "T" Codes for Heatstroke Dx
Question: We have had more patients than usual who have presented for heatstroke, but we a...
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ED Coding And Reimbursement Alert - 2018; Volume 21, Number 8
ICD-10:
You'll Find New Appendicitis, Ecstasy Poisoning Codes on Oct. 1
The 2019 diagnosis codes include over 300 additions. From time to time, every ED coder wi...
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Appeals:
Your Appeals May Rely on These 4 Essentials
Don't underestimate the power speaking to insurers. As payers increasingly step up denial...
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Diagnosis Coding:
Can You Select the Diagnosis Codes for These ED Visits?
Hint: Not all pneumonia codes are in the pneumonia section of ICD-10. One of the most int...
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Reader Question:
Differentiate Arthrocentesis, Aspiration
Question: We report code 20600 (Arthrocentesis, aspiration and/or injection, small joint o...
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Reader Question:
Know Which Fracture Dx to Apply
Question: We have a patient who underwent a 3-view ankle X-ray for a left, displaced later...
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Reader Question:
Know the Code for Diaper Rash
Question: We had a parent present to the ED with her one-year-old son, and she suspected h...
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Reader Question:
Vermillion Repair? Look to 40650
Question: We recently repaired a laceration on the vermillion border of a patient's lip. T...
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Reader Question:
Get the Rhythm of 93040
Question: I am unsure about some of the ECG reporting rules. Could you please explain the ...
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Reader Question:
Could Texas Begin Denying "Non-Emergent" ED Visits?
Question: I read your article last month about Missouri's efforts to curb Anthem's policy ...
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You Be the Coder:
Does This Constitute An Invalid Code?
Question: In your article last month, “Compare Your Claims Against This MAC's Top Denial...
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ED Coding And Reimbursement Alert - 2018; Volume 21, Number 7
Denials:
One State Aims to Quell Anthem's ED Denials
As complaints mount, states are taking issues into their own hands. As complaints continu...
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ICD-10:
Pinpoint Fracture Diagnoses With These Quick Tips
Hint: Osteoporotic fractures might not be coded from the fracture section. It's likely th...
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Claim Denials:
Compare Your Claims Against This MAC's Top Denial Reasons
Hint: Some codes have prerequisites before you can report them. Denials happen to every E...
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Reader Question:
Get the Scoop on Myositis Coding
Question: Our provider documented that a patient was suffering from pain, swelling, tender...
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Reader Question:
Crush Injury Dx Requires More Details
Question: The physician treated a patient for "crush injury, lower forearm." What ICD-10 c...
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Reader Question:
Which Code Applies to Splinter Removal?
Question: Our physician saw a patient who had been running barefoot on a wooden deck, whic...
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Reader Question:
Nail Down These Vent Management Rules
Question: What are we required to document when the physician administers ventilation mana...
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Reader Question:
Is MIPS Meaningful Use No More?
Question: Our ED just got a handle on the MIPS and other fairly new programs, and now our ...
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Reader Question:
Find out What to Do With PHI
Question: We are moving to a different location, and staff members are purging old patient...
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You Be the Coder:
Ensure Thorough Documentation for X-Rays
Question: The ED performed a four-view x-ray of a patient's left knee, including lateral a...
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ED Coding And Reimbursement Alert - 2018; Volume 21, Number 6
Compliance:
Recent Medicare Audit Shows Where EDs Stand in Terms of Opioid Prescriptions
If your opioid prescription count is higher than average, don't panic, reps say. Many ED ...
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Denials:
Payers Issue Fresh Denials for Repeat Chest X-Rays, EKGs
Remember to use modifiers when necessary to denote medically necessary repeat tests. If y...
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ICD-10:
Prove Urine Test Medical Necessity With Accurate ICD-10 Codes
Your ED bills these services frequently, so pinpoint the right codes. When patients prese...
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Reader Question:
How to Prevent Mobile Device Issues
Question: Our staff members now carry tablets where they record their documentation. Twice...
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Reader Question:
Don't Forget Seventh Character for Fractures
Question: We treated a patient with multiple fractured ribs and we reported a six-characte...
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Reader Question:
Know the Keywords to Report Otitis Media Diagnoses
Question: We see a lot of ear infections in the ED, and often the physician will only docu...
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You Be the Coder:
Can You Code This COPD Diagnosis?
Question: A patient who has had COPD for nine years presented to our ED with serious diffi...
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ED Coding And Reimbursement Alert - 2018; Volume 21, Number 5
Modifiers:
Last-Minute Change Saves Practices from Further Modifier 25 Pay Cuts
Tip: Use this as an opportunity to review your modifier 25 processes. Emergency departmen...
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Billing:
Perfect Your Medicare Secondary Payer Claims With These Tips
It's the practice's responsibility to know which payer to bill first, Part B rep says. Pi...
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Use This Chart to Determine Primary Payer
There are myriad situations that you may see when you have to determine whether Medicare i...
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ICD-10:
Heed These ED-Specific ICD-10 FAQs
From gastritis to conjunctivitis: These are the right diagnosis codes to use. Flu season ...
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Reader Question:
Heed This Laceration Repair, Debridement Advice
Question: We recently treated a patient who was involved in a skateboard accident, which r...
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Reader Question:
Remember to Sign Those Orders
Question: We have problems with one of our ED doctors who orders lab tests and doesn't sig...
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Reader Question:
Pinpoint the Myositis Code
Question: Our physician documented that a patient was suffering from pain, swelling, tende...
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Reader Question:
Does This Scenario Require More Information?
Question: A parent brought a newborn patient to the ED with nasal discharge, nasal swellin...
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You Be the Coder:
Which E/M Code Applies When ED Patient Becomes Inpatient?
Question: We saw a patient in the ED for a possible broken bone following a car accident. ...
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ED Coding And Reimbursement Alert - 2018; Volume 21, Number 4
Documentation:
CMS Rethinks Its Policy on Students' E/M Documentation
New policy will be a plus for EDs nationwide. Every hospital-based staff member has seen ...
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E/M Coding:
Here's How to Determine When 99285 is Warranted
Tackle this confusing question by checking these documentation items. Does your doctor fe...
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ICD-10:
Can You Answer These ICD-10 Coding Questions?
Confirm medical necessity with a sharp diagnosis coding knowledge. As most ED coders are ...
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Reader Question:
Know How to Answer the SNF Question
Question: We saw a patient for 24 hours in the emergency department and two days in observ...
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Reader Question:
Know the Epistaxis Encounter Rules
Question: A 17-year-old patient presented to the ED after being hit in the face with a soc...
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Reader Question:
Consider Time When Selecting Breathing Treatment Codes
Question: Is it true that if the physician performs continuous inhalation treatment (94644...
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Reader Question:
Understand How to Code Multiple Eyelash Removals
Question: We saw a patient who complained of eye irritation and pain. She had several eyel...
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Reader Question:
Check Payer Policies Before Filing Appeals
Question: We performed imaging for a patient who had a complaint of abdominal pain, and we...
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You Be the Coder:
Differentiate Open, Closed Fractures
Question: How can we tell the difference between an open fracture and a closed fracture? ...
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ED Coding And Reimbursement Alert - 2018; Volume 21, Number 3
ED Payments:
Anthem Extends Policy Denying "Inappropriate" ED Visits to 3 More States
Physician groups, lawmakers fight against expanded policy. Private insurer Anthem Blue Cr...
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Part B Payments:
CMS: ED Practitioners Log Among the Highest Improper Payment Rates
The agency says EDs improperly billed over $315 million to Part B. Emergency departments ...
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Patient Privacy:
CMS Lays out New Texting Guidelines — Are You at Risk?
CMS explicitly prohibits texting physician orders. Texting is such a ubiquitous form of c...
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Reader Question:
Avoid Modifier 25 for Multiple Procedures
Question: We performed a nail bed repair and an arm laceration repair during the same enco...
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Reader Question:
Use ICD-10's Supplementary Words to Your Advantage
Question: Our ED physician diagnosed a patient with a traumatic central perforation of the...
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Reader Question:
ICD-10 Offers More Than One GERD Dx
Question: A patient presented to our ED because of burning throat painand denied chest pai...
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Reader Question:
Multiple Dx Codes Aren't a Necessity for Modifier 25
Question: One of our physicians is of the belief that he must link any E/M encounter that ...
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Reader Question:
Differentiate Flu From Flu-Like Symptoms
Question: We have had a record number of patients coming to the ED with flu-like symp...
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You Be the Coder:
Count Muscles to Pinpoint TPI Code
Question: A patient reported to the ED complaining of spasming pain in her left calf. Afte...
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ED Coding And Reimbursement Alert - 2018; Volume 21, Number 2
Benchmarking:
How Would Your 99285 Coding Stand up in An Audit?
Plus: Find out which states had the highest and lowest percentage of high-level ED claims....
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Is Your State Among the Biggest Billers of 99285?
Although the average percentage of services billed with 99285 in the US was 55 percent dur...
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ICD-10 Quiz:
Can You Select the Right Dx Code for These Emergent Conditions?
Your ED may see these diagnoses frequently, but do you know how to report them? Every ED ...
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Patient Privacy:
Determine Whether New HIPAA Update Impacts Your Rights to Discuss Patients' Opioid Issues
Do you know who you can share this information with? As emergency department providers st...
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Reader Question:
Evaluate Coding Options for Consults Outside the ED
Question: A hospital attending physician needed our ED physician's opinion on an inpatient...
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Reader Question:
Do All Burns Require Burn Codes?
Question: A patient reported to the ED with her shoulders painfully burned after spending ...
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Reader Question:
Differentiate Viral Pinkeye From Allergic
Question: We saw a patient with pinkeye related to a specific virus, and we've never seen ...
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You Be the Coder:
Know What Constitutes An 'Inducement"
Question: We keep hearing that we should be more careful about which cases to bill as obse...
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ED Coding And Reimbursement Alert - 2018; Volume 21, Number 1
2018 Payments:
CMS Delays Decision on Whether to Adjust E/M Pay for EDs
Plus: Payments have been set for the new codes that debut Jan. 1. When CMS published its ...
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Claim Submissions:
Avoid These 10 Mistakes When Submitting Claims to Medicare
Hint: Part B MACs even have a favorite font for your claim forms. When it comes to submit...
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Critical Care:
Pinpoint Accurate Critical Care Codes Every Time With 5 Quick Tips
Yes, you can administer critical care in the ED. As most ED coders know, critical care se...
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Reader Question:
Calculate Lesion Sizes With Accuracy
Question: Our ED physician removed a benign lesion and isn't sure how to calculate the exc...
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Reader Question:
Discover When ICD-10 PCS Applies
Question: Should we be capturing ICD-10-PCS codes in our emergency department? We currentl...
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Reader Question:
Does RADS Code As Asthma?
Question: An adolescent patient presented to our ED with asthma-like symptoms: coughing, w...
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You Be the Coder:
Which Code Applies to Split ED Service?
Question: A doctor in our emergency department removed nasal packs that a different doctor...
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