ED Coding and Reimbursement Alert

Besides heralding a new year, Jan. 1 also brings a new batch of edits to the Correct Coding Initiative (CCI). Fortunately, version 8.0 will have little impact on emergency department coders, according to Jim Blakeman, senior vice president for coding quality assurance with Healthcare Business Resources Inc., in Bala Cynwyd, Pa. Most of the edits pertain only to new codes and components that are bundled within them. There are really no surprises, and I dont expect coders will find any problems in these edits, he says.
 
Chapter 1 outlines a requirement that modifier -25 (significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) be added to distinct E/M services that are provided on the same day as procedures that carry an XXX-day global period. These XXX procedures are diagnostic tests like EKGs (e.g., 93000, electrocardiogram, routine ECG with at least 12 leads; with interpretation and report).
 
In many instances, ED physicians provide separate E/M services when a diagnostic test is ordered. For instance, an elderly patient may present with foot pain. The physician completes a history and physical to determine what is causing the pain.
 
Ultimately, the doctor may order an x-ray to determine if a stress fracture is the cause. If properly documented, the ED visit may be reported with the -25 modifier, along with the code for the x-ray (e.g., 73630, radiologic examination, foot; complete, minimum of three views).
 
ED coders would have reported both services in the past. The only change, therefore, is that they consistently append the -25 modifier.
 
This change was, in essence, implemented and rescinded in October 2000 with version 6.3 of the CCI edits. At that time, this modified policy was outlined in thousands of new edits, which created sufficient confusion to cause their suspension. The new approach for 2002 accomplishes the same objective, but with less disorder.