ED Coding and Reimbursement Alert

Question: What is a FAST exam, and how should coders report the procedure? I overheard a fellow coder talking about an accident victim who came in last night needing a FAST exam.


Massachusetts Subscriber

Answer: The ED physician will typically perform a FAST exam (focused abdominal sonography for trauma) on patients with trunk or abdominal trauma to check for internal bleeding. It is a tool that allows the ED physician to assess the severity of the patient's condition and make decisions about treatment.

The test is a two-procedure process. Part one of the FAST exam is a limited transthoracic echocardiography to check for pericardial fluid. Code the thoracic component with 93308 (Echocardiography, transthoracic, real-time with image documentation [2D] with or without M-mode recording; follow-up or limited study).

The second part of the exam involves a limited abdominal study to check for fluid. For this study, you should report 76705 (Ultrasound, abdominal, real-time with image documentation; limited [e.g., single organ, quadrant, follow-up]).

Modifier alert: When coding for a FAST exam in the ED, you should append modifier 26 (Professional component) to both 93308 and 76705 to show that you are coding only the professional portions of the exam.

Consider this example: A patient reports with severe pain in his chest and visible bruising on his abdomen after a motor vehicle accident. After performing a level-five E/M service and finding bruises on the patient's chest and abdominal walls, the physician performs a FAST exam.

On this claim, you should report the following:

- 93308 for the thoracic component

- 76705 for the abdominal study

- modifier 26 linked to 93308 and 76705 to show that you are coding for the professional portions of the codes

- 922.1 (Contusion of chest wall) and 922.2 (Contusion of abdominal wall) linked to 93308 and 76705 to represent the patient's condition.

- 99285 (Emergency department visit for the evaluation and management of a patient, which requires these three key components: a comprehensive history; a comprehensive examination; and medical decision-making of high complexity) for the E/M service

- modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) attached to 99285 to indicate a separate service from the FAST exam

- 922.1 and 922.2 linked to 99285 to represent the patient's condition.