ED Coding and Reimbursement Alert

Question: I understand we should add all procedures that are currently on the physicians charge master to the facilitys charge master with associated charges. Should we also add procedures commonly performed by emergency department (ED) nurses, such as earwax removal, catheterizations, etc.?

Sandy Colson
Albuquerque, N.M.

Answer: All procedures performed in the facility on an outpatient basis should be captured through assignment of a code, either by medical records coders or via the charge master, says Kathy Zmuda, CPC, lead inpatient coder, Cigna Health Care of Arizona, Phoenix. This includes procedures normally performed by ED nurses, such as removal of impacted earwax (69210), infusion therapy (Q0081) and injections (90782-90788).

Some procedures, however, are not separately payable under ambulatory payment classifications (APCs), and thus it may not be worthwhile to assign separate codes to these. For instance, the code for simple catheterization (53670) has been assigned an APC with a status indicator of N, which means that payment for this service has been packaged into payment for other APCs.

Although your physicians charge master is a good place to start, there may be some charges on it that are either inappropriate for facility billing or are not separately payable. For instance, 93042 (rhythm ECG, interpretation and report only) may appear on your physicians charge master, yet this is not a reportable code for the facility. The associated facility code would be 90341 (rhythm ECG, tracing only).

In addition, the physician charges associated with each code may not appropriately capture facility resources.