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ED Coding and Reimbursement Alert

MPFS Final Rule:
Check Out What’s Likely for 2024 MPFS
If you're hoping for a CF increase, prepare to be disappointed. Even though the COVID-19 ... Read more
Fracture Care Primer:
I.D. These Fracture Care Scenarios for Optimal Coding
Do you know how to code for nasal fracture repair without manipulation? When your ED ph... Read more
Diagnosis Deep Dive:
Know MI Types for Confident Coding
Also, do you know how to code a healed MI? Knowing how to code a myocardial infarction (M... Read more
You Be The Coder:
Decipher Notes to Nail Carditis Dx
Question: Encounter notes indicate that a patient suffers from “rheumatoid carditis... Read more
Reader Question:
Get More Details for Sinusitis Dx
Question: If a patient has a diagnosis of acute sinusitis, how should I choose the IC... Read more
Reader Question:
Use Specific Dx on Flu With GI Issues
Question: When the physician diagnoses a patient with influenza with gastrointestinal... Read more
Reader Question:
Do This on Puncture Aspiration of Breast Cyst
Question: The ED physician performs puncture aspiration on a solitary cyst in a patie... Read more
Reader Question:
Drill Down to Find Proper Neck Fx Dx
Question: Encounter notes indicate that the ED physician treated a patient with sever... Read more
Procedure Coding:
Tap This Advice for Spinal Puncture Coding Success
Often, decision to perform puncture made during ED E/M. If you're not careful, encounters... Read more
ICD-10 Coding:
Make Migraine Concerns Disappear With Dx Coding Smarts
Deep dive into characters required for accurate Dx selection. There aren't many diagnos... Read more
Documentation:
Use This Advice to Successfully Query Physicians
Keep provider interactions as simple as possible. If you require additional information ... Read more
Reader Questions:
Use This Guide to Acute Laryngitis, Tracheitis Dx Codes
Question: Encounter notes indicate that the physician treated a patient with ‘acute subg... Read more
Reader Questions:
Get More Info Before Coding Serous Otitis Media
Question: Encounter notes indicate that during a level-three ED evaluation and management ... Read more
Reader Questions:
Keep Up With PHE Types
Question: Are all public health emergencies (PHEs) the same? Do they carry the same flexib... Read more
You Be the Coder:
Multiple Plantar Wart Destruction
Question: What is the proper code for destruction of three plantar warts from a patient's ... Read more
E/M Coding:
Address ED E/M Concerns to Straighten Out Coding
If complexity isn't clear in documentation, miscoding could be the result. Patients that ... Read more
Condition Coding:
Stay Atop Stroke Coding With CPT®, ICD-10 Smarts
Your coding will likely depend on your physician roster. A patient reporting to the ED ... Read more
ICD-10 Coding:
Reduce Heart Attack Coding Anxiety With These Tips
Do you know how to code for a healed MI? Patient's reporting to the ED for treatment of ... Read more
Reader Questions:
Use E/M for Broken Nose Tx Without Manipulation
Question: A patient presents to the ED with a bloody and bruised nose they suffered ... Read more
Reader Questions:
Use This Guidance to Report … Guidance
Question: Encounter notes indicate that the ED physician performed a puncture aspirat... Read more
Reader Questions:
Remember 7th Character on This Diabetes Dx
Question: I'm having a little trouble with the abbreviations on an encounter note. Wh... Read more
Reader Questions:
Shigellosis Dx Depends on Type
Question: A patient reports to the ED complaining of severe stomach cramps and diarrh... Read more
You Be the Coder:
Multiple Lacerations With ED E/M
Question: A patient reports to the ED with three lacerations on their right arm. Two ... Read more
FBR Coding:
Look to These Codes for Eye FBR
If physician doesn't find an FB, remember new Dx codes. Patients often report to the ED w... Read more
Clip and Save:
Check Out These Dx Codes for Eye FBRs
Some, but not all, diagnoses are acceptable for conjunctival and corneal FBRs. When your ... Read more
Coding Corner:
Test Coding Smarts With These Wound Repair Scenarios
Do you know the external cause Dx code for tap dancing? ED coders have to be ready to co... Read more
Compliance:
Use This Advice to Declare Preemptive Strike on Denials
With procedures in place, you can reduce denials. Claims denials can be exhausting for a... Read more
Reader Questions:
Remember 7th Character on This Diabetes Dx
Question: Encounter notes indicate that a patient suffers from type 2 diabetes with m... Read more
Reader Questions:
Make Sure All Breaches Are Taken Seriously
Question: We uncovered a small data breach in our practice that impacted about 225 pa... Read more
Reader Questions:
Do This When Counting BSA for Debridement
Question: If the ED physician debrides infected skin from 18 percent of a patient's b... Read more
You Be the Coder:
Coding for Stress Fracture
Question: If the encounter notes indicate the patient suffered a stress fracture to t... Read more
ICD-10 2024:
Pathological Fx, FB Sensation Highlight New Code List
Get ready for more migraine codes. ICD-10 is at it again. In a summertime tradition, the... Read more
ICD-10 2024:
Meet the Parents: Converted Codes Get New ‘Kids’
When a code is converted to parent, new codes are part of the deal. In ICD-10 2024, there... Read more
AI Learning:
Adjust to AI With Appendix S
CPT® isn't waiting to see if AI will stick around. In any year, the CPT® code book is b... Read more
Reader Questions:
ICD-10 2024 Also Features W Code Update
Question: I know that there are a lot of relevant new ICD-10 codes for primary diagnoses. ... Read more
Reader Questions:
Use This Dx for Wallenberg Syndrome
Question: Encounter notes indicate that the ED physician treated a patient suffering from ... Read more
Reader Questions:
Eye These ICD-10 Codes for Blepharoconjunctivitis
Question: Encounter notes indicate that the physician treated a patient with “blepharoco... Read more
You Be the Coder:
Pilonidal Cyst I&D
Question: Encounter notes indicate that the physician performed an ED evaluation and manag... Read more
Testing:
On ED EKGs, Code With Caution
Remember when to report an E/M service instead of EKG code Patients that report to ... Read more
E/M Coding:
Descriptor Changes Mark 2023 Hospital/Inpatient Codes
Here's how new E/M guidelines are challenging coders. Just about everyone is aware that C... Read more
Case Study Corner:
Cover All Bases in This E/M-Intubation Scenario
Hint: Know what's included — and excluded — from critical care. When patients report... Read more
Reader Questions:
Listen Up: Synonyms Light Path to Cellulitis Dx
Question: Encounter notes indicate that a patient suffered from ‘auricular cellulit... Read more
Reader Questions:
The Clock Is Tick-ing: E/M or Procedure Code for Removal?
Question: A 10-year-old patient reports to the ED complaining of a fever, chills, and... Read more
Reader Questions:
Use This Guidance for Adult BMI
Question: An obese patient with gastrointestinal issues came into the ED, and the pro... Read more
You Be the Coder:
Heatstroke and ICD-10 Codes
Question: A patient reported to the ED suffering from exertional heatstroke they suff... Read more
Emergency Procedures:
Check Technique When Coding Endotracheal Intubation
Do you know which techniques qualify for 31500? When your ED physician performs endotrach... Read more
Integumentary Repair Coding:
Look to These Factors to Nail Wound Repair Coding
Do you know when you should use E/M code instead? Patients that present to the ED for w... Read more
Compliance:
Get Documentation Ducks in a Row Before Filing Claim
Here's why open communication between providers, coders is vital. The difference between ... Read more
Reader Questions:
Do This on ED Hydrations
Question: The ED physician sees a patient complaining of nausea with vomiting. After ... Read more
Reader Questions:
Know Carbuncle/Furuncle Differences for Accurate Dx
Question: What is the difference between a carbuncle and a furuncle of the external e... Read more
Reader Questions:
Account for Work This Way on Refused Test
Question: Suppose a physician orders a diagnostic test, such as an electrocardiogram ... Read more
You Be the Coder:
ICD-10 and Alcohol-Related Seizures
Question: The ED physician treated a patient with alcohol-related epileptic seizures.... Read more
Procedure Coding:
Know Fix Types, Plug Nosebleed Repair Coding Holes
Remember, the physician might stop nosebleed during E/M. When a patient reports to the E... Read more
Compliance:
Refresh on Rules to Stay HIPAA Compliant Post-PHE
When the PHE ends, will your practice be ready? The COVID-19 public health emergency (PHE... Read more
Denials:
Contesting a Denial? Strengthen Case With 5 Useful Tips
Practice patterns could hold key to denial prevention. Filing appeals for denied claims ... Read more
You Be the Code:
Broken Ribs, E/Ms, and X-Rays
Question: Encounter notes indicate that the ED physician performed an evaluation and ... Read more
Reader Questions:
Check Payer Policy Before Critical Care Coding
Question: Encounter notes indicate that the ED physician performed 75 minutes of crit... Read more
Reader Questions:
Get More Info for More Detailed Hemorrhage Dx
Question: Encounter notes indicate that the provider treated a patient suffering from... Read more
Reader Questions:
Look Around; You’ll Find Notes for Periarthritis Dx
Question: Encounter notes indicate that a patient suffers from “periar­thritis NOS... Read more
Testing:
Slow Down, Count All Services in FAST Exam
Are you familiar with the term eFAST? Trauma patients are a given in the ED setting, and ... Read more
Modifier Madness, Part 2:
Get 25/57 Claims Right by Separating E/M
Billable E/M service might be obvious, but never assume it. When your ED provider perfor... Read more
Procedure Coding:
Know I&D Differences to Flesh Out Correct Codes
Multiple I&D will mean 10061. When your provider performs incision and drainage (I&... Read more
You Be the Coder:
Don’t Let Payer Poke Holes in Your Puncture Wound Dx
Question: Encounter notes indicate the ED physician treated a patient with a puncture... Read more
Reader Questions:
Go Below Code Descriptor for Dx Synonyms
Question: Encounter notes indicate that the physician treated a patient with “acute... Read more
Reader Questions:
Get Ready for PHE to End
Question: I read that there's been another extension to the public health emergency (... Read more
Reader Questions:
Use Modifiers to Nail Debridement/Avulsion Coding
Question: When the provider performs nail debridement or avulsion, how do I code for ... Read more
Reader Questions:
Terminology Smarts Vital to Accurate Eating Disorder Dx
Question: I'm seeing three different codes for binging and purging conditions in ICD-... Read more
Reader Questions:
Acronym Smarts Lead to Correct TBI/LOC Dx
Question: Encounter notes indicate that the ED physician provided 62 minutes of criti... Read more
Reader Questions:
Know Suppurative/Nonsuppurative Differences for Otitis Media Dx
Question: A patient came in recently with a bad ear infection. Our provider documente... Read more
Critical Care Primer:
Know the Basics of Critical Care for Optimal Coding
Remember, critical illness or injury is … critical to reporting 99291. Critical care ha... Read more
E/M FAQ:
Keep MDM Atop Your E/M Checklist
Uncover all potential MDM elements in each encounter. Coding for ED evaluation and manag... Read more
Diagnostic Services:
Reveal no Weakness in Achilles Rupture Coding
Do you know how to code for a Thompson test? When a patient ruptures their Achilles tendo... Read more
Reader Questions:
MPFS Decides on Final CF
Question: I remember that the Medicare Physician Fee Schedule (MPFS) final rule came ... Read more
Reader Questions:
Use New Observation Rules for This Encounter
Question: Encounter notes indicate that on Feb. 2, 2023, the provider performed initi... Read more
Reader Questions:
Dig Into Notes for Most Accurate Concussion/Fall Diagnoses
Question: A patient presented to the ED complaining of intense headaches, blurred vis... Read more
Reader Questions:
Pause on I&D Code Unless Provider Does This
Question: I'm familiar with the incision and drainage (I&D) codes, but I don't th... Read more
Reader Questions:
Choose Toxicity Type Before Coding for Chemo Px
Question: A patient came in complaining of vomiting following chemotherapy. The chem... Read more
You Be the Coder:
Dx Coding for Chest/Throat Maladies
Question: Encounter notes indicate the physician diagnosed a patient with arterial br... Read more
MPFS Final Rule:
CPT®, CMS Still Split on Critical Care Add-On
Count on coders to use correct payment rules. The 2023 Medicare Physician Fee Schedule (... Read more
ICD-10 2023:
Use These FAQs to Tackle SDoH Updates
Look to the guidelines for all the info you need. On Oct. 1, more than 1,700 ICD-10-CM co... Read more
Modifier Madness, Part 1:
Use Documentation to Master Modifier 25 Usage
Encounter notes could be difference between E/M-25 and no E/M. In the coding world, few m... Read more
Reader Question:
Code Additional Services During TPIs
Question: When the provider performs trigger point injections (TPIs), can you code se... Read more
Reader Question:
Code Order Matters for Optimal Claims
Question: The ED physician performed closed treatment of a metacarpal fracture withou... Read more
Reader Question:
Use This Dx for Long COVID Patients
Question: A patient presented with fatigue that affects their daily life, a lingering... Read more
You Be the Coder:
Double Foot FBRs
Question: Encounter notes indicate that the provider performed superficial foreign body re... Read more
Medicare Physician Fee Schedule:
CF Cut Causing Coding Community Consternation
Congress still has time to act, however. The second the Centers for Medicare & Medica... Read more
E/M Coding:
Calculate Tetanus Shot MDM Risk Carefully
How should a tetanus shot factor into calculating MDM risk? When coding an evaluation an... Read more
Injections:
Get a Shot of Knowledge on These ED Injections
Remember to count muscles for accurate TPI count. No matter what, the ED coders are going... Read more
Reader Question:
Drill Down for Most Accurate Spinal Fx Dx
Question: Encounter notes indicate that a patient reported to the ED with severe pai... Read more
Reader Question:
Use Anatomy Smarts to Code Carotid Artery Stenosis Confidently
Question: A patient is diagnosed with carotid artery stenosis in the left and right arteri... Read more
Reader Question:
Concurrent Sinus/Flu Infections Call for This Dx
Question: A patient with congestion, thick nasal drainage, facial pain, and a headache pre... Read more
You Be the Coder:
Double Digital Block
Question: Encounter notes indicate that the ED provider performed a digital block on two l... Read more
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