ED Coding and Reimbursement Alert

Test your coding knowledge. Determine how you would code this situation before looking at the box below for the answer.
Question: How should I bill for laboratory charges that an ED physician orders and interprets? I need to know the rules for the professional side of the service. Kentucky Subscriber



Answer: You cannot charge for lab test interpretation codes as a professional service. The ED physician's interpretation is bundled into the E/M medical decision-making (MDM). Consequently, you should add one point in the MDM, for example, when the physician orders a complete blood count (CBC).

Even if your physician goes down to the lab to independently examine the slide to look at the cells (that is, blasts in a child with a high white blood count), you should recognize this additional work by adding two points under the amount and complexity of data, not by billing the tests separately. The CBC's official reading is still a facility service and not billable on the professional side.

There may be one exception, however: fecal guaiac testing (82270). This is a bedside test that the physician performs and reads. Most group practices do not bill for this service, and the facility side bills out the interpretation because it recoups the cost of the card and developer. Most groups may fight with radiology and cardiology departments over reimbursement, but given the small revenue associated with interpreting stool guaiac, they eventually forego a battle with the hospital.