Wiki Laceration Repair-learning more about

[nanc512]

I am learning more about ER coding, normally we audit and code for facilities who use physicians who are on staff at the facility. I have very little experience with a physician being a part of a different group and I am trying to learn.

If a patient has a laceration repair, is that coded with the facility portion or the physician portion? Is there a good reference site for what codes are normally billed on the physician side? I have only see the E/M codes, but ran across one that had a laceration repair as well.

Thanks.

Nan

 

[eadun2000]

repairs are for both pro and facility side. All injections, infusions and hydrations are done on the facility side, UNLESS the physician SPECIFICALLY PERFORMS IT THEMSELVES, not the nurses. Splinting is captured on the pro side if the doc performed it (also captured on the facility side too).

 

[LTibbetts]

I am learning more about ER coding, normally we audit and code for facilities who use physicians who are on staff at the facility. I have very little experience with a physician being a part of a different group and I am trying to learn.

If a patient has a laceration repair, is that coded with the facility portion or the physician portion? Is there a good reference site for what codes are normally billed on the physician side? I have only see the E/M codes, but ran across one that had a laceration repair as well.

Thanks.

Nan

Hi Nan,

The ACEP (American College of Emergency Physicians) has a lot of information regarding facility and physician coding that you might find very useful.
So, if a patient comes into the ER, has a laceration and the doc sutures the lac, there would be a facility fee charged and a pro fee charged for the suture repair done by the provider. Facility fees are developed individually by each hospital per their own in-house guidelines. The physician portion of the billing is made up of E&M pro fees and multiple other CPT procedure codes (sutures, splint application, dental blocks, fracture care, etc.). If the patient only has a lac repair, then that would be the only pro fee charged, not an E&M. If the patient had another complaint, above and beyond the lac, and this required an additional exam, then you could code the E&M level, along with a modifier, and also code for the lac repair.
I'm not sure if this is the type of answer you were looking for, but I hope it helps. Definitely look into the ACEP website, though. I'm sure it will be useful for you.