ED Coding and Reimbursement Alert

ED physicians unfamiliar with proper coding for trauma often undercode and undercharge for these services. But often a third-party payer, such as an automobile insurer or workers' compensation carrier, is responsible for payment. No matter who is paying the bill, full compensation is lost unless all separately billable procedures are documented, says David McKenzie, director of the reimbursement department for the American College of Emergency Physicians. "If you're not billing for these, you're leaving money on the table," McKenzie says.
 
Mike Williams, president of the Abaris Group in Walnut Creek, Calif., who has spent nearly 10 years educating ED physicians and coders on how to turn their trauma units around, says financial stress comes from improper coding and not knowing where to collect the fees. For instance, many times trauma patients in motor-vehicle accidents (MVA) have automobile insurance on top of their regular medical insurance. Sometimes trauma cases are work-related, so workers' compensation claims must be filed. "If you charge and bill trauma correctly, there is potential for a significant source of revenue," he says.
 
Lorraine Began, CPC, billing compliance monitor for the Metrohealth System in Cleveland, says her coders refer to a "cheat sheet" when reviewing documentation for a trauma case. The list includes most procedures that can be billed separately for trauma. Some of the treatments include CPR (92950), cardioversion (92960), thoracotomy (32160-54), pericardiotomy (33020-54), endotracheal intubation (31500), tube thoracotomy (32020-54), cricothyrotomy, thoracentesis (32000*), pericardiocentesis (33010), peritoneal lavage or DPL (49080*), transcutaneous pacemaker (92953), transvenous pacemaker (33210), ventilator (94656), transfusion (36430) and therapeutic phlebotomy (99195). Of course, other procedures, such as lacerations, casting/strapping and fracture care, also qualify as separately billable.
Bill Related Procedures Separately From E/M  
One example of billing for additional services beyond E/M with a trauma patient might include laceration repairs.  For example, an MVA patient presents to the ED with a laceration on the left forearm, and head trauma. The patient is alert on arrival but was unconscious when the emergency medical services (EMS) arrived at the scene. The ED physician examines the patient to determine if any other injuries exist and orders x-rays to rule out fractures or internal injuries. A CAT scan is ordered because the patient had lost consciousness. The ED physician's documentation must support the level of E/M service and whether the patient fits into critical care.
 
Because the patient is alert and briefly lost consciousness, the ED physician performs a comprehensive history and physical examination and codes the case 99285 (emergency department visit for the evaluation and management of a patient, which requires a comprehensive history; a comprehensive examination; and medical decision making of high complexity). However, to be compensated for any other procedures the physician performs, modifier -25 (significant, [...]