ED Coding and Reimbursement Alert
Part B Payments:
New Fee Schedule Reveals Lower Conversion Factor for 2022
Plus: Look for changes in how split/shared visits will be viewed. If you were looking for... Read more
New Fee Schedule Reveals Lower Conversion Factor for 2022
Plus: Look for changes in how split/shared visits will be viewed. If you were looking for... Read more
Reimbursement:
Fix These Common Billing Issues to Prep for a Prosperous 2022
Hint: Eligibility issues may be easy to fix and will help you maximize revenue. As you p... Read more
Fix These Common Billing Issues to Prep for a Prosperous 2022
Hint: Eligibility issues may be easy to fix and will help you maximize revenue. As you p... Read more
Coding For Cardiac Presentaions:
Solidify Your Heart Attack Coding Knowledge With 4 Quick Tips
Look to the I21 code series in most cases. Chest pain is one of the most common reasons t... Read more
Solidify Your Heart Attack Coding Knowledge With 4 Quick Tips
Look to the I21 code series in most cases. Chest pain is one of the most common reasons t... Read more
Reader Questions:
Differentiate Hypoxia From Hypoxemia
Question: I have a physician's note that documents the patient's conditions as acute... Read more
Differentiate Hypoxia From Hypoxemia
Question: I have a physician's note that documents the patient's conditions as acute... Read more
Reader Questions:
Look to M Series for Dupuytren’s Contracture
Question: I'm stumped. Notes indicate that the provider performed a collagenase injection ... Read more
Look to M Series for Dupuytren’s Contracture
Question: I'm stumped. Notes indicate that the provider performed a collagenase injection ... Read more
Reader Questions:
Know the Alternative Words for Rotator Cuff Tear
Question: Encounter notes indicate that the provider performed a level three ED E/M servic... Read more
Know the Alternative Words for Rotator Cuff Tear
Question: Encounter notes indicate that the provider performed a level three ED E/M servic... Read more
You Be the Coder:
Fancy a Code for Bird Fancier’s Lung
Question: A patient arrived at our ED with inflammation of the lungs, and was experiencing... Read more
Fancy a Code for Bird Fancier’s Lung
Question: A patient arrived at our ED with inflammation of the lungs, and was experiencing... Read more
Foreign Body Removal:
Master FBR Coding With 6 Quick Tips
From gunshots to splinters, understand when something qualifies as a foreign body removal... Read more
Master FBR Coding With 6 Quick Tips
From gunshots to splinters, understand when something qualifies as a foreign body removal... Read more
Patient Privacy:
Halt Your Faxing Faux Pas With a Few Simple Steps
Medical professionals still fax frequently, and your staff members should understand how t... Read more
Halt Your Faxing Faux Pas With a Few Simple Steps
Medical professionals still fax frequently, and your staff members should understand how t... Read more
Electrocardiogram Coding:
Eliminate ECG Confusion by Differentiating Services
Hint: You may need to count leads before you can select the right code. Reporting ECGs (e... Read more
Eliminate ECG Confusion by Differentiating Services
Hint: You may need to count leads before you can select the right code. Reporting ECGs (e... Read more
Reader Questions:
Extinguish Smoke Inhalation Coding Fires
Question: Our ED physician saw a patient presenting with symptoms of coughing, shortness o... Read more
Extinguish Smoke Inhalation Coding Fires
Question: Our ED physician saw a patient presenting with symptoms of coughing, shortness o... Read more
Reader Questions:
Nail Down Codes for Bimalleolar Fracture Repair
Question: My ED provider performed closed treatment of a lateral and medial malleoli ankle... Read more
Nail Down Codes for Bimalleolar Fracture Repair
Question: My ED provider performed closed treatment of a lateral and medial malleoli ankle... Read more
Reader Questions:
Observe These Observation Diagnosis Rules
Question: Should we report the observation diagnosis codes (Z03-Z05) as primary diagnoses ... Read more
Observe These Observation Diagnosis Rules
Question: Should we report the observation diagnosis codes (Z03-Z05) as primary diagnoses ... Read more
You Be the Coder:
Can You Code a Retinal Migraine?
Question: Notes indicate that the provider treated a patient with a “retinal migraine.... Read more
Can You Code a Retinal Migraine?
Question: Notes indicate that the provider treated a patient with a “retinal migraine.... Read more
Nosebleed Coding:
5 Key Tips Help You Code Nasal Hemorrhages With Ease
Hint: Differentiate simple from complex to nail the coding rules. When patients present t... Read more
5 Key Tips Help You Code Nasal Hemorrhages With Ease
Hint: Differentiate simple from complex to nail the coding rules. When patients present t... Read more
ED Coding:
Could You Be Coding Wound Debridement Incorrectly?
Reviewers took a close look at reporting debridement services. Reporting wound debridemen... Read more
Could You Be Coding Wound Debridement Incorrectly?
Reviewers took a close look at reporting debridement services. Reporting wound debridemen... Read more
How Does Wound Care Differ From Debridement?
If you're working to sharpen your skin debridement codes, you may be curious about the rol... Read more
If you're working to sharpen your skin debridement codes, you may be curious about the rol... Read more
Billing:
Be Ready for Balance Billing Changes Before 2022
Changes go into effect Jan. 1, 2022. Balance billing has been in the news recently, in p... Read more
Be Ready for Balance Billing Changes Before 2022
Changes go into effect Jan. 1, 2022. Balance billing has been in the news recently, in p... Read more
Reader Questions:
Differentiate Food Allergy From Intolerance
Question: We often see patients at the ED who have allergies or intolerance regarding thi... Read more
Differentiate Food Allergy From Intolerance
Question: We often see patients at the ED who have allergies or intolerance regarding thi... Read more
Reader Questions:
Understand the Low Back Pain Options
Question: How do I code acute or chronic lower back pain? Even with the new ICD-10 codes, ... Read more
Understand the Low Back Pain Options
Question: How do I code acute or chronic lower back pain? Even with the new ICD-10 codes, ... Read more
You Be the Coder:
Understand Acute Vs. Chronic Tonsillitis
Question: When can tonsillitis be classified as acute, and when is it considered chronic? ... Read more
Understand Acute Vs. Chronic Tonsillitis
Question: When can tonsillitis be classified as acute, and when is it considered chronic? ... Read more
Reimbursement:
ED Providers Could See E/M, Critical Care Changes Under New Proposal
Plus: CMS proposes extending ED telehealth services through 2023. ED providers could see ... Read more
ED Providers Could See E/M, Critical Care Changes Under New Proposal
Plus: CMS proposes extending ED telehealth services through 2023. ED providers could see ... Read more
ICD-10-CM Coding:
Latest ICD-10-CM Update Includes New Codes for Cough, COVID-19
Plus: EDs can benefit from new back pain diagnosis codes. You'll see 191 new codes adde... Read more
Latest ICD-10-CM Update Includes New Codes for Cough, COVID-19
Plus: EDs can benefit from new back pain diagnosis codes. You'll see 191 new codes adde... Read more
Billing:
Boost Your Appeals Success Rate With 5 Key Tips
Remember: Know why you're appealing a claim before you hit ‘submit.' Appealing claims ... Read more
Boost Your Appeals Success Rate With 5 Key Tips
Remember: Know why you're appealing a claim before you hit ‘submit.' Appealing claims ... Read more
Reader Questions:
Understand the “No Surprises Bill”
Question: We just read about the “no surprises bill,” which seems to apply to EDs, bu... Read more
Understand the “No Surprises Bill”
Question: We just read about the “no surprises bill,” which seems to apply to EDs, bu... Read more
Reader Questions:
Know the Fracture Type to Select Code
Question: Our ED provider treated a patient who was diagnosed with a displaced bimalleolar... Read more
Know the Fracture Type to Select Code
Question: Our ED provider treated a patient who was diagnosed with a displaced bimalleolar... Read more
You Be the Coder:
Can You Report EKG With Critical Care?
Question: We are reviewing guidelines for an EKG done with critical care (99291-+99292), w... Read more
Can You Report EKG With Critical Care?
Question: We are reviewing guidelines for an EKG done with critical care (99291-+99292), w... Read more
ICD-10 Coding:
3 Case Studies Help You Follow the Clues to the Right Diagnosis Code
Hint: Diagnosis codes alone won't support medical necessity. Your emergency department do... Read more
3 Case Studies Help You Follow the Clues to the Right Diagnosis Code
Hint: Diagnosis codes alone won't support medical necessity. Your emergency department do... Read more
HIPAA:
Evaluate Your ED’s Privacy Compliance With a Few Simple Tips
The government is ramping up HIPAA violations, not slowing them down. When the ED gets bu... Read more
Evaluate Your ED’s Privacy Compliance With a Few Simple Tips
The government is ramping up HIPAA violations, not slowing them down. When the ED gets bu... Read more
ICD-10 Coding:
Differentiate Sequela From Manifestation to Pinpoint Diagnosis Code
Take the extra time to read the guidelines before you select a code. You may not have the... Read more
Differentiate Sequela From Manifestation to Pinpoint Diagnosis Code
Take the extra time to read the guidelines before you select a code. You may not have the... Read more
Reader Questions:
What’s ‘Diabetes 1.5’?
Question: Our provider recently documented a patient as having both type 1 and type 2 diab... Read more
What’s ‘Diabetes 1.5’?
Question: Our provider recently documented a patient as having both type 1 and type 2 diab... Read more
Reader Questions:
Decide Whether Diarrhea Is a Colitis Symptom
Question: The indication of my provider's report details the patient having both diarrhea ... Read more
Decide Whether Diarrhea Is a Colitis Symptom
Question: The indication of my provider's report details the patient having both diarrhea ... Read more
Reader Questions:
UHC Delays New ED Policy
Question: When will UnitedHealthcare begin its new policy of denying ED facility visits th... Read more
UHC Delays New ED Policy
Question: When will UnitedHealthcare begin its new policy of denying ED facility visits th... Read more
Reader Questions:
Can You Differentiate EMR From EHR?
Question: At our ED, we often use the terms EMR and EHR interchangeably, but our new IT m... Read more
Can You Differentiate EMR From EHR?
Question: At our ED, we often use the terms EMR and EHR interchangeably, but our new IT m... Read more
You Be the Coder:
How Should You Report Ventricular Tachycardia?
Question: My ED physician documented a diagnosis of ventricular tachycardia. Which ICD-10-... Read more
How Should You Report Ventricular Tachycardia?
Question: My ED physician documented a diagnosis of ventricular tachycardia. Which ICD-10-... Read more
E/M Visits:
Collect for Your ED E/M Visits by Avoiding These Common Mistakes
Remember: Your EMR can't do it all. If you're relying on your electronic medical record ... Read more
Collect for Your ED E/M Visits by Avoiding These Common Mistakes
Remember: Your EMR can't do it all. If you're relying on your electronic medical record ... Read more
ED Visits:
Repeat ED Visits on the Same Day? Take This Advice
Your first step will involve differentiating between the reasons for the first and second ... Read more
Repeat ED Visits on the Same Day? Take This Advice
Your first step will involve differentiating between the reasons for the first and second ... Read more
ICD-10 Coding:
Coding Pneumonia in the ED? Check This Guide
Your best bet is to nail down the cause of pneumonia first, experts say. When patients pr... Read more
Coding Pneumonia in the ED? Check This Guide
Your best bet is to nail down the cause of pneumonia first, experts say. When patients pr... Read more
Reader Questions:
Take Your Time When Coding Aortic Root Abscess
Question: What ICD-10-CM code should I report for an aortic root abscess? Maine Subscribe... Read more
Take Your Time When Coding Aortic Root Abscess
Question: What ICD-10-CM code should I report for an aortic root abscess? Maine Subscribe... Read more
Reader Questions:
Get Specific When Coding Sciatica
Question: The ED physician diagnosed a patient with sciatica. Which code applies? Tenness... Read more
Get Specific When Coding Sciatica
Question: The ED physician diagnosed a patient with sciatica. Which code applies? Tenness... Read more
You Be the Coder:
Evaluate Burn Size Before Choosing a Code
Question: Our ED physician treated a 14-year-old patient who had a second-degree burn on t... Read more
Evaluate Burn Size Before Choosing a Code
Question: Our ED physician treated a 14-year-old patient who had a second-degree burn on t... Read more
ED E/M Coding:
10 Tips Help You Improve Your ED’s History Documentation
Avoid using vague statements, and be as thorough as possible every time. Every emergency... Read more
10 Tips Help You Improve Your ED’s History Documentation
Avoid using vague statements, and be as thorough as possible every time. Every emergency... Read more
Medicare Provider Enrollment:
Take This Quiz to Ensure You Know How to Bring New Providers on Board
Yes, you can appeal an enrollment decision. Even if you've been working with the Medicare... Read more
Take This Quiz to Ensure You Know How to Bring New Providers on Board
Yes, you can appeal an enrollment decision. Even if you've been working with the Medicare... Read more
Reader Questions:
Avoid Blanket Claim Resubmissions
Question: We have several claims that our payer is taking more than 30 days to process or... Read more
Avoid Blanket Claim Resubmissions
Question: We have several claims that our payer is taking more than 30 days to process or... Read more
Reader Questions:
Check State Rules on Insurer Responsibility
Question: When a patient comes to the ED for treatment following a motor vehicle accident,... Read more
Check State Rules on Insurer Responsibility
Question: When a patient comes to the ED for treatment following a motor vehicle accident,... Read more
Reader Questions:
Always Correct Claims That Have Errors
Question: Within the past few months, on two occasions my billing department submitted cla... Read more
Always Correct Claims That Have Errors
Question: Within the past few months, on two occasions my billing department submitted cla... Read more
You Be the Coder:
Can You Code Increased Sensitivity?
Question: What is the best diagnosis code for allodynia — and what, exactly, does it mea... Read more
Can You Code Increased Sensitivity?
Question: What is the best diagnosis code for allodynia — and what, exactly, does it mea... Read more
Pediatric Visits:
Quiz: Can You Code These Pediatric ED Scenarios?
Test yourself against these four situations. Not every patient who comes into your ED can... Read more
Quiz: Can You Code These Pediatric ED Scenarios?
Test yourself against these four situations. Not every patient who comes into your ED can... Read more
Documentation:
Ease Your Documentation Stress With These Key Strategies
Hint: Maintain all records for at least seven years. The lifeblood of your ED claims wil... Read more
Ease Your Documentation Stress With These Key Strategies
Hint: Maintain all records for at least seven years. The lifeblood of your ED claims wil... Read more
Observation Coding:
Confirm That Your Observation Coding Skills Are Up to Date
Remember Medicare's differing rules for eight-hour stays. Knowing whether you can report ... Read more
Confirm That Your Observation Coding Skills Are Up to Date
Remember Medicare's differing rules for eight-hour stays. Knowing whether you can report ... Read more
Reader Question:
Is Modifier 51 Required?
Question: We have a coder who puts modifier 51 (Multiple procedures) on almost all claims... Read more
Is Modifier 51 Required?
Question: We have a coder who puts modifier 51 (Multiple procedures) on almost all claims... Read more
Reader Questions:
Pull the Trigger on This Trigger Finger Code
Question: The ED encounter notes indicate that the provider saw a patient for pain in her ... Read more
Pull the Trigger on This Trigger Finger Code
Question: The ED encounter notes indicate that the provider saw a patient for pain in her ... Read more
You Be the Coder:
Can You Code This Laceration Encounter?
Question: A 36-year-old patient with diabetes presented to the ED noting that she had drop... Read more
Can You Code This Laceration Encounter?
Question: A 36-year-old patient with diabetes presented to the ED noting that she had drop... Read more
Reader Questions:
Can You Report Suspected STI?
Question: Our provider wants to report code A64 when they test a patient for a sexually tr... Read more
Can You Report Suspected STI?
Question: Our provider wants to report code A64 when they test a patient for a sexually tr... Read more
Medication Assisted Treatment:
Tighten Your Documentation to Collect for MAT
EDs can now bring in reimbursement for medication-assisted treatment. When patients with ... Read more
Tighten Your Documentation to Collect for MAT
EDs can now bring in reimbursement for medication-assisted treatment. When patients with ... Read more
Urgent Care Coding:
Get to Know These Essential Urgent Care Coding Tips
Be ready for new E/M guidelines that took effect January 1. Some ED practices have expan... Read more
Get to Know These Essential Urgent Care Coding Tips
Be ready for new E/M guidelines that took effect January 1. Some ED practices have expan... Read more
Medicare FAQS:
6 FAQs Help You Collect for COVID Vaccines, Modifier 50, and More
Wondering why your claims are denying due to incorrect patient info? Get the answers stra... Read more
6 FAQs Help You Collect for COVID Vaccines, Modifier 50, and More
Wondering why your claims are denying due to incorrect patient info? Get the answers stra... Read more
You Be the Coder:
Can You Find a Code for Neck Sprain?
Question: Our physician treated a patient complaining of neck pain. Encounter notes indica... Read more
Can You Find a Code for Neck Sprain?
Question: Our physician treated a patient complaining of neck pain. Encounter notes indica... Read more
Reader Questions:
Ensure You Meet Time Thresholds Before Reporting 99291
Question: Can we report critical care for a patient with suicidal ideation? Our coders hav... Read more
Ensure You Meet Time Thresholds Before Reporting 99291
Question: Can we report critical care for a patient with suicidal ideation? Our coders hav... Read more
Reader Questions:
Understand When Multiple X-rays Should Be Coded
Question: A patient came into the urgent care following a bicycle accident and the doctor ... Read more
Understand When Multiple X-rays Should Be Coded
Question: A patient came into the urgent care following a bicycle accident and the doctor ... Read more
Reader Questions:
Differentiate Closed, Open Wounds
Question: We've noticed that one of our physicians reports the diagnosis code for a closed... Read more
Differentiate Closed, Open Wounds
Question: We've noticed that one of our physicians reports the diagnosis code for a closed... Read more
Compliance:
CMS: ED E/M Visits Responsible for $224M in Improper Payments
Fortunately, the 9 percent error rate in this category came down from last year's total. ... Read more
CMS: ED E/M Visits Responsible for $224M in Improper Payments
Fortunately, the 9 percent error rate in this category came down from last year's total. ... Read more
Check the Coding Errors That CMS Evaluated
CMS identified a total of $25.74 billion in total improper payments among providers sampl... Read more
CMS identified a total of $25.74 billion in total improper payments among providers sampl... Read more
Telehealth Coding:
Answers to These 7 Telehealth FAQs Can Help You Collect Faster
Remember the importance of modifier 95, Part B reps noted. Although you've likely been p... Read more
Answers to These 7 Telehealth FAQs Can Help You Collect Faster
Remember the importance of modifier 95, Part B reps noted. Although you've likely been p... Read more
You Be the Coder:
Can You Code This Dermal Debridement?
Question: Our provider saw a patient who had a superficial linear abrasion that extended f... Read more
Can You Code This Dermal Debridement?
Question: Our provider saw a patient who had a superficial linear abrasion that extended f... Read more
Reader Questions:
Check the I&D Codes Carefully
Question: Our ED physician performed an incision and drainage (I&D) of a masseter musc... Read more
Check the I&D Codes Carefully
Question: Our ED physician performed an incision and drainage (I&D) of a masseter musc... Read more
Reader Questions:
Mind Your Modifiers for Double Tests
Question: We often do double flu tests, one for flu A and one for flu B. We bill code 8780... Read more
Mind Your Modifiers for Double Tests
Question: We often do double flu tests, one for flu A and one for flu B. We bill code 8780... Read more
Patient Relations:
Confidently Answer 4 Common Questions from ED Patients
From billing to observation facts, find out how to respond. “I stayed overnight in the ... Read more
Confidently Answer 4 Common Questions from ED Patients
From billing to observation facts, find out how to respond. “I stayed overnight in the ... Read more
Part B Payment:
Fee Schedule Delivers New Code to Help EDs Collect for MAT
If you perform medication assisted treatment, G2213 can help you collect for it. Emergenc... Read more
Fee Schedule Delivers New Code to Help EDs Collect for MAT
If you perform medication assisted treatment, G2213 can help you collect for it. Emergenc... Read more
ICD-10 Coding:
Eliminate Stress When Coding Back Pain Diagnoses
Use this guide to navigate the challenges of the M54.- code range. Patients often come t... Read more
Eliminate Stress When Coding Back Pain Diagnoses
Use this guide to navigate the challenges of the M54.- code range. Patients often come t... Read more
You Be the Coder:
Get Specific for UTI Diagnoses
Question: Which diagnosis should we report for a urinary tract infection (UTI) of a male p... Read more
Get Specific for UTI Diagnoses
Question: Which diagnosis should we report for a urinary tract infection (UTI) of a male p... Read more
Reader Questions:
Understand How Outpatient E/M Codes Work
Question: Our urgent care center saw a patient who was 8 months old for an upper respirato... Read more
Understand How Outpatient E/M Codes Work
Question: Our urgent care center saw a patient who was 8 months old for an upper respirato... Read more
Reader Questions:
Can You Report Multiple Coronary Codes?
Question: I'm reading an impression that notes atherosclerotic heart disease of the native... Read more
Can You Report Multiple Coronary Codes?
Question: I'm reading an impression that notes atherosclerotic heart disease of the native... Read more
Reader Questions:
Don’t Count on Appeals for Unprocessable Claims
Question: We received an “unprocessable” claim from our Medicare Administrative Contra... Read more
Don’t Count on Appeals for Unprocessable Claims
Question: We received an “unprocessable” claim from our Medicare Administrative Contra... Read more
ED Payments:
CMS Delivers Both Pros and Cons in the Latest Fee Schedule
Plus: The updated fee schedule also includes changes to the conversion factor, telehealth ... Read more
CMS Delivers Both Pros and Cons in the Latest Fee Schedule
Plus: The updated fee schedule also includes changes to the conversion factor, telehealth ... Read more
Critical Care:
Check This Primer to Understand When Modifiers Apply to Critical Care
Modifier 25 isn't always billable, this expert says. When your ED specialists perform cr... Read more
Check This Primer to Understand When Modifiers Apply to Critical Care
Modifier 25 isn't always billable, this expert says. When your ED specialists perform cr... Read more
Clip And Save:
Know What’s Included in the Critical Care Codes
Although there are some services that you can report along with the critical care codes (9... Read more
Know What’s Included in the Critical Care Codes
Although there are some services that you can report along with the critical care codes (9... Read more
You Be the Coder:
Can You Report 2 Units of Infusion Code?
Question: Progress notes indicate that my ED provider performed an intravenous (IV) infusi... Read more
Can You Report 2 Units of Infusion Code?
Question: Progress notes indicate that my ED provider performed an intravenous (IV) infusi... Read more
Reader Questions:
Check ICD-10-CM Guidelines for Info on Observation Diagnoses
Question: Should we report the observation diagnosis codes (Z03-Z05) as primary diagnoses ... Read more
Check ICD-10-CM Guidelines for Info on Observation Diagnoses
Question: Should we report the observation diagnosis codes (Z03-Z05) as primary diagnoses ... Read more
Reader Questions:
Consider Whether External Cause Codes Fit the Bill
Question: One of our ED physicians recently performed a reduction of a traumatic fracture ... Read more
Consider Whether External Cause Codes Fit the Bill
Question: One of our ED physicians recently performed a reduction of a traumatic fracture ... Read more
Reader Questions:
Clarify How to Report Facial Palsy
Question: Our ED physician performed a level-four E/M service; the notes read that th... Read more
Clarify How to Report Facial Palsy
Question: Our ED physician performed a level-four E/M service; the notes read that th... Read more
Reader Questions:
You’ll Need Multiple Dx Codes for Multiple Injuries
Question: Encounter notes indicate that the ED provider treated a patient for “laceratio... Read more
You’ll Need Multiple Dx Codes for Multiple Injuries
Question: Encounter notes indicate that the ED provider treated a patient for “laceratio... Read more