ED Coding and Reimbursement Alert

News You Can Use:
CMS Cuts CF Further Than Originally Proposed
Final rule makes conversion factor even lower. People who wanted the Centers for Medicare... Read more
From E/M to Procedure:
Depth, Instrumentation Separate Cerumen Removal Codes
Do you know how the provider typically diagnoses impacted cerumen? When a patient reports... Read more
Lesions:
Go Into the Margins for Lesion Removal Coding
Do you know how to calculate lesion removal Tx area? If a patient reports to the ED req... Read more
Reader Questions:
Don’t Fret About Coding Stress Views
Question: Encounter notes indicate that ED physician performed a level-four evaluatio... Read more
Reader Questions:
Zero in on Crushing Injury Dx With More Info
Question: Encounter notes indicate that a patient suffered from a crushing injury to ... Read more
Reader Questions:
Don’t Ever Do This With Short Critical Care Sessions
Question: Encounter notes indicate that the physician provided 23 minutes of critical... Read more
Reader Questions:
Cold Dx Calls for This Code
Question: With cold and flu season already ramping up, we are seeing a disordinate a... Read more
Reader Questions:
Do This When Assigning ICD-10 Codes
Question: We find the Medicare billing process a bit confusing and aren't sure what ... Read more
You Be the Coder:
Coding CTs for Shoulder Cysts
Question: A patient reports to the ED complaining of left shoulder pain. The provider... Read more
Critical Care:
Know Nuances When Choosing Between 99285, 99291
Remember, high-level ED E/Ms can resemble critical care. When your provider treats a very... Read more
ICD-10 Coding:
Put Sequencing Atop Your Priority List When Choosing Dx Codes
Patient outcome, and your reimbursement, can be affected by poor sequencing. Proper seq... Read more
Compliance:
Reduce Duplicate Claims With Advice Regarding Modifiers
Do you know the basics on repeat modifiers? When Medicare denials start piling up at yo... Read more
Reader Questions:
Go Digital for Finger Fx Modifier
Question: Encounter notes indicate that after a level-four evaluation and management (E/M... Read more
Reader Questions:
Slow Down When Considering Coding Strapping Twice
Question: If the provider performs strapping on a patient's ankle and foot, can we report ... Read more
Reader Questions:
Look for More Accurate Code Before Using Modifier 52
Question: Encounter notes indicate that the ED physician performed an evaluation and ... Read more
Reader Questions:
Check Bronchoscopy Type Before Choosing Code
Question: The ED physician performs a bronchoscopy. How should I report this procedure? A... Read more
You Be the Coder:
Nonspecific Lumbago Calls for This Code
Question: Encounter notes indicate that the provider treated a patient with “lumbago NOS... Read more
News You Can Use:
CPT® 2023: New US Code Highlights ED Changes
Also, remember the symbols that accompany new codes. ED coders have been getting hammered... Read more
ICD-10 2023:
New Code Sets Amplify Aortic Aneurysm Codes
Here's the converted codes that are now ‘parents.' The hits just keep on coming with ... Read more
Fracture Care:
Close the Loop on These Fracture Coding Questions
Did you know traction can accompany closed fracture treatment? When your ED physician per... Read more
Fracture Care:
Coding 101: Start Here for Fracture Care Success
There might be a separate E/M — but don't assume it. Even the most seasoned coder can f... Read more
Reader Quesitons:
Use This, not That, for Blood Draws
Question: I recently used 99195 (Phlebotomy, therapeutic (separate procedure)) for a ... Read more
Reader Questions:
Congress Protects Telehealth — for now
Question: Have there been any official, federal government-led moves to make any of ... Read more
Reader Questions:
Leave This Surgical Modifier off This Splint Application Scenario
Question: Notes indicate that after a level-three ED evaluation and management (E/M) ... Read more
Reader Questions:
Know Subluxation Location for These Diagnoses
Question: After performing a level-four ED evaluation and management (E/M) service f... Read more
You Be the Coder:
Shoulder Separation and Repair
Question: The ED physician performs a level-four ED evaluation and management (E/M) s... Read more
E/M 2023:
ED Code Descriptors Reflect MDM Focus
Check out the new rules for 99281-99285. Coding for ED evaluation and management (E/M) se... Read more
E/M 2023:
CPT® Hits Reset on Inpatient, Observation Codes
Here's what you'll use instead of 99217 next year. If you thought the ED codes contained... Read more
News You Can Use:
2023 Proposed Rule Features Conversion Factor Cut
Don't expect another 3% boost for next year. With COVID still causing trouble and practi... Read more
Reader Questions:
Separate Paragraphs Could Key Modifier 22 Success
Question: I was told documentation for modifier 22 (Increased procedural services) sh... Read more
Reader Questions:
Be Proactive When Locating Prodrome Symptoms
Question: The provider diagnosed the patient with “migraine w/prodrome, no status m... Read more
Reader Questions:
Don’t Shortchange Yourself in This Splinting Scenario
Question: The ED physician performed an evaluation and management (E/M) service for a... Read more
You Be the Coder:
Scour Notes for Every Osteomyelitis Dx Detail
Question: Encounter notes indicate that the ED physician diagnosed acute hematogenous... Read more
ICD-10 2023:
Prep for New Concussion/TBI Dx Codes
Remember, these codes take effect before 2023. The numbers are in, and they're staggerin... Read more
ICD-10 2023:
Get Ready for More Substance Use, Poisoning Codes
Also, see how well 2-wheeled vehicle accidents are represented in 2023. ED coders will wa... Read more
Minor Procedures:
Follow These Steps to FBR Success
Deciding if an FBR is complicated is … complicated. People engaged in summertime activ... Read more
Reader Questions:
Get More Info Before Coding This ECG
Question: Encounter notes indicate that the physician performed a level-five ED eval... Read more
Reader Questions:
March on With Fracture Dx After Getting More Info
Question: Encounter notes indicate that the provider treated a patient with a “Mar... Read more
Reader Questions:
Yay or Neigh on Charley Horse Dx?
Question: Notes indicate that the patient had “charley horse l calf.” Are there ... Read more
You Be the Coder:
Slow Down, Look for FAST Exam Clues
Question: I have notes in front of me that indicate that the ED physician performed a... Read more
Debridements:
I.D. Debridement Type, Then Perform Code Search
Hint: There are codes specifically for debridement with fracture care. In the summer, pat... Read more
Injections:
Target Joint Size for Sure Shot Coding
Do you know what separates small/intermediate/ major joints? When patients report to the... Read more
Modifier Madness:
Partial Service Coding Depends on 26, 54
Do you know when to use professional component modifier? There are times when your physic... Read more
Reader Questions:
Eye Conjunctivitis Dx Carefully
Question: A patient presents with eye irritation and discharge. After a level-three E... Read more
Reader Questions:
Contrast Smarts Will Keep Your MRI Claim From Coming Back
Question: The provider performed an ED evaluation and management (E/M) service for a ... Read more
Reader Questions:
Target Muscles on Trigger Point Shots
Question: If the ED physician performs trigger point injections (TPIs) to alleviate p... Read more
You Be the Coder:
Alternate Terms and Nonspecific Diagnoses
Question: Encounter notes indicate that the provider treated a patient with “blood-... Read more
E/M Coding:
Follow 5 Simple Steps to Benchmark Your ED Practice’s Way to Precise Coding
Where do your emergency physicians stand when it comes to national trends? Nearly every ... Read more
Clip And Save:
Check This Breakdown of Which Codes ED Providers Are Reporting Nationwide
Once you compare your ED practice's benchmarking data over time, you may want to take the ... Read more
Diagnosis Coding:
Go Beyond R10.- for Abdominal Pain Coding
From symptoms and age to severity, you need multiple data points to choose a diagnosis. ... Read more
Summer Coding:
Test Yourself With 2 Insect Bite Encounter Scenarios
Do you know how to code for these common warm-weather scenarios? When an insect bites or ... Read more
Reader Questions:
Look to S13.- Series for Neck Sprain Diagnosis
Question: The ED provider treated a patient who came in complaining of neck pain that's be... Read more
Reader Questions:
Never Base E/M Code Choice on Condition
Question: Our ED sees a lot of patients with multiple comorbidities, and many of thes... Read more
You Be the Coder:
Can You Code This Asthma Scenario?
Question: A patient who says they have a long history of mild persistent asthma presents t... Read more
2022 E/M Coding:
Find the Answers to Your Pressing Split/Shared E/M Visit Questions
The new rule for 2022 does apply to observation care, reps say. As most emergency departm... Read more
Diagnosis Coding:
Can You Pinpoint These Tachycardia ICD-10-CM Codes?
Check these simple scenarios and determine which diagnosis code you'd select. When a pat... Read more
Rash Coding:
Check This Guide to Skin Rash Coding
Hint: Rashes impact both adults and children, but many codes remain the same. When a ras... Read more
Reader Questions:
Understand Specificity for UTIs
Question: We've been reporting N39.0 (Urinary tract infection, site not specified) for uri... Read more
Reader Questions:
Use These Codes to Report Septic Pulmonary Embolisms
Question: Which ICD-10-CM codes should I report for septic pulmonary embolisms? Alaska Su... Read more
Reader Questions:
Understand Anatomy for Ultrasound Codes
Question: Encounter notes indicate that the provider performed an ultrasound (US) on the p... Read more
Reader Questions:
Understand Infusion Coding Rules
Question: Progress notes indicate that my ED provider performed an intravenous (IV) infusi... Read more
Reader Questions:
Can You Code Deep Abscess I&D?
Question: Our ED provider saw a 29-year-old female patient with complaints of acute pain a... Read more
You Be the Coder:
Do You Know the Headache Options?
Question: Some of our coders are having trouble getting the ICD-10-CM codes for our headac... Read more
Part B Coding:
Check These 2022 ED Coding and Billing Tips, Straight From Part B Reps
Wondering about the new telehealth modifier? We've got answers. From reporting split/shar... Read more
Modifiers:
Capture Separate E/M Pay With 3 Tips
Understand what counts as ‘separately identifiable.' Reporting a separate evaluation a... Read more
Use This Handy Tool to Differentiate Between Modifiers 25 and 57
Your modifier 25 claims should meet all of the following criteria: The E/M occurs on th... Read more
Reader Questions:
Understand Splinter Removal Coding
Question: A patient came to the ED after she got a splinter in her foot from running... Read more
Reader Questions:
Consider This Fracture Presentation
Question: Notes indicate that the ED physician performed a level 5 evaluation and man... Read more
Reader Questions:
Check ‘L’ Series for Diaper Rash Code
Question: We had a parent present to the ED with her one-year-old son, and she suspec... Read more
You Be the Coder:
Can You Tally the HPI Elements in This Note?
Question: Thanks for your article on the history of present illness (HPI) last month.... Read more
ICD-10:
3 Tips Help You Code ODs in the ED
Hint: Evaluate whether an overdose is accidental or intentional before finding the right d... Read more
E/M Coding:
Perfect Your HPI Knowledge to Report E/M Services in the ED
HPI is often misunderstood, but always important. One of the most important questions t... Read more
Clip And Save:
Nail HPI Elements With This Simple Chart
If you aren't sure which parts of the documentation count toward the different HPI element... Read more
Vent Management:
Can You Justify the Vent Management Code? Check Documentation Before You Bill
Hint: Critical care code may be better choice than 94002 in some cases. When does vent ... Read more
Reader Questions:
Check for Tophi Before Coding Gout
Question: According to the medical documentation, the patient has drug-induced chroni... Read more
Reader Questions:
Understand Status Asthmaticus
Question: A 24-year-old patient visited our urgent care facility with an acute exacer... Read more
Reader Questions:
Count the Elements for Physical Exam
Question: Sometimes I'm coding a chart and can't decide how to classify the document... Read more
You Be the Coder:
Can You Code Snowboarder’s Ankle?
Question: A 28-year-old patient visited our urgent care facility with complaints of right ... Read more
Compliance:
ED Physicians’ Coding Errors Decreased, Despite the COVID-19 Pandemic
Incorrect coding was the biggest culprit among ED providers' claims. Emergency medicine p... Read more
These States Logged the Highest — and Lowest — Error Rates
CMS and the Medicare Administrative Contractors (MACs) process claims from all 50 U.S. sta... Read more
E/M Coding:
Miscoding ROS Level Could Cost You $51
Understand how ROS ties into your overall E/M charges. If you're not able to correctly a... Read more
Wound Repairs:
Get to Know the Basics of Wound Closure to Select the Right Codes
Complex repair vs. basic? We've got the scoop. When a patient presents to the ED with a... Read more
Reader Questions:
Look to Multiple X-Ray Codes for This Scenario
Question: Encounter notes indicate that the provider performed X-rays on two areas of... Read more
Reader Questions:
Understand How to Code Vague Scenarios
Question: A father came to our ED asking for blood work to be done on a child that wa... Read more
Reader Questions:
Find out When to Code Chronic Conditions
Question: One of our providers is saying that we should always code chronic condition... Read more
You Be the Coder:
Which Diagnosis Codes Apply to This Cat Bite Encounter?
Question: Our ED provider recently saw an elderly patient who had a cat bite infected with... Read more
E/M Coding:
Perfect Your ED E/M Coding Skills With 3 Quick FAQs
Hint: Avoid writing “HPI negative” in your documentation. Choosing the correct E/M le... Read more
Critical Care:
Bust 5 Critical Care Myths for Clean Claims
Remember to keep an eye on the clock when performing critical care. Although critical ca... Read more
ICD-10-CM Coding:
Optimize Your Use of 5th, 6th Characters to Ensure Pain-Free Migraine Coding
Migraine may be among your most rule-intensive diagnoses in the ED. Choosing the correc... Read more
Reader Questions:
Understand How to Code TIAs
Question: We often see patients with cerebral transient ischemic attacks (TIAs), but ... Read more
Reader Questions:
Look to N43 Series for Hydrocele
Question: We recently treated a patient with a hydrocele. Which ICD-10-CM codes shoul... Read more
Reader Questions:
Use 1 Code for Pneumonia With Flu
Question: We saw a 35-year-old patient who was complaining of flu-like symptoms that ... Read more
You Be the Coder:
Can Waterjet Debridement Be Coded Separately?
Question: A patient came to the ED for treatment of a pressure ulcer on her lower bac... Read more
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