ED Coding and Reimbursement Alert

Question: How should I code aerosol breathing treatments provided by the physicians in our emergency room?

Connecticut Subscriber

 
Answer: This is an area where ED coders and billers must proceed with caution. Generally, there is no medical justification for hospital-based emergency physicians to perform nebulizer treatments and this is an area considered to be potentially abusive by Medicare. Typically, these treatments are provided by the hospital staff and would be included in the facility charges. The use of and number of aerosol treatments would factor into the complexity and risk of the E/M service but, unless personally performed by the physician, it would be difficult to code as a physician service.

  Reader Questions and You Be The Coder were reviewed by John Turner, MD, FACEP, medical director for coding and documentation at TeamHealth, Inc. in Knoxville, Tenn.; and Tracie Christian, CPC, CCS-P, director of coding for ProCode in Dallas.