ED Coding and Reimbursement Alert

Every emergency department (ED) knows the story. Emergency medical technicians (EMTs) bring in a male patient with chest pain (786.5 series), nausea (787.02) and dizziness (780.4). Soon after entering the emergency department, the patient goes into cardiac arrest (427.5).

Technically, the EMTs are relieved of responsibility once they bring the patient to the hospital, but in reality they often lend a hand, according to John Turner, MD, PhD, medical director for documentation and coding compliance, healthcare financial services at TeamHealth, a physician staffing firm in Knoxville, Tenn. Frequently they will assist, if the patient is critical. But thats basically from the goodness of their heart; they dont have to do it. Its not in their job description. In some cases, if they didnt come in and help us, wed be behind the eight ball when it gets very busy.

Some coders run into problems determining codes for procedures performed by emergency medical services (EMS) personnel inside the hospital. A rule of thumb is that unless the EMTs are employed by the hospital, they usually dont bill for services after the patient reaches the emergency department.

The ED staff bills as soon as the staff takes over, says Caral Edelberg, CPC, CCS-P, president of Medical Management Resources Inc., an emergency medicine coding company in Jacksonville, Fla. As long as the ED physician and staff are involved, they can bill for it.

The same principle applies to the facility side, Turner says, because any services EMS performs inside generally will use the hospitals equipment. Once treatment is provided at the hospital, hospital charges apply.

Say a patient comes in full arrest with active CPR (92950, cardiopulmonary resuscitation), Edelberg says. EMS brings the patient into the code room, and doctors and nurses take over. The facility level will reflect that.

That said, both facility and physician coders must be cautious. Documentation of EMS is often spotty because the EMTs normally arent involved in any of the record keeping, although there are exceptions.



Hospital Rules Take Precedence

Although most metropolitan hospitals contract EMS services, many hospitals, particularly in rural areas, have their own EMS division, Turner says. If the hospital runs its own EMS service and employs the EMTs, that hospital must have its own way of billing for their services, and coders should be aware of the hospital-specific rules.

In general, hospitals cant bill for the work performed by emergency medical technicians, Turner says. But its not a major portion of the procedures done in the hospitals. Its just a friendly gesture.

If an EMT administers an antibiotic (90788, intramuscular injection of antibiotic [specify]) or attaches a splint to a broken finger (29130-29131, application of finger splint), the hospital cant bill for [...]