CCI 18.0 Update: Watch for These Two Codes, Bundled into Dozens of Procedures   (January 2012)

You need to know these edits if you report 20527 or 29582
New codes aren’t the only things that affect your ED coding in 2012 “Correct Coding Initiative (CCI) edits version 18.0 went into effect Jan. 1, 2012, with 15,530 new edit pairs, says Michael A. Granovsky, MD, FACEP, CPC, President of LogixHealth, a medical coding and billing company in Bedford, MA.
Although few of the new edits are focused on frequently used emergency medicine services, [...]

Coding Strategies: Wake Up To These Deep Sedation Insider Tips   (January 2012)

You could be coding more deep sedation services this year in the ED, thanks to recent changes. Your claims’ accuracy will depend on careful documentation of the duration and level of consciousness achieved. Read on for expert advice on modifier use and payer regulations dealing with anesthesia.
What’s driving the trend: The advent of newer sedation drugs, particularly propofol, have led to greater sedation effectiveness and less recovery time for the patient after deep sedation, thus [...]

Coding Tips: Splinting or Strapping? These Tips Help You Decide   (January 2012)

Hint: Look to materials to narrow down your selection.
When a patient reports to the ED with an injury that requires a splint or strap, coders must know the difference between the two in order to assign the correct procedure code. Review these rules to make sure your code choice is secure.
Use 2 Scenarios As Guides CPT® includes a special section on application of casts, strapping and splints arranged by body area (i.e. body and upper [...]

You Be the Coder: Consider this example   (January 2012)

Question:
A 67-year-old female presents to the ED after falling off a three-step ladder. After a level 3 E/M service and review of radiographs, the physician determines that the patient sustained a non-displaced fracture of the distal left ulna. Due to the swelling, the physician applies a plaster molded splint for immobilization and protection of the fracture. The patient is then referred to an orthopedic clinic for follow-up treatment and casting in two days.
Answer:
You should [...]

Reader Question: Distinguish Open From Closed Fracture Treatment   (January 2012)

Question:
What is the difference between an open and closed fracture treatment?
California Subscriber
Answer:
You’ll need to know the difference between the two, because your CPT® code choice is based on whether the physician performed open or closed repair.
Closed definition: When the physician performs closed fracture treatment, it means that she did not have to surgically open the fracture site in order to repair the break. So if the operative report indicates that the physician performed [...]

Reader Question: Can You Report an ED E/M And Critical Care on the Same Day?   (January 2012)

Question:
Is there official documentation where both critical care and an ED level can be billed on the same date of service? I understand it is rare (most patients come in critical) and requires additional work to get reimbursement and that not all payers will reimburse for both on the same day, but it is a possible billing situation, correct or incorrect? And is there any official documentation to support this situation?
Mississippi Subscriber
Answer:
CPT® specifically states that [...]

Reader Question: Tread Carefully When Dealing with Tarsal Fractures   (January 2012)

Question:
My physician saw a patient for a non-displaced tarsal bone fracture, which did not require manipulation. Rather than applying a cast, the physician placed a prefabricated short leg removable cast. I spoke with my physician and the patient will not require much in the way of additional treatment. She was instructed to follow up with the orthopedist in 2 weeks. Can this be reported as fracture care?
Wisconsin subscriber
Answer:
Yes, this would be reported using code, [...]

Reader Question: The CMS Shared Services Documentation Exemption Only Applies to E/M Services   (January 2012)

Question:
If an emergency physician sees a patient and performs an ED E/M service, but has a Non Physician Provider come in to perform a laceration repair and both provider’s properly document in the chart, and sign the chart, do the E/M and procedure get billed under the physician, or does the E/M get billed under the physician and the procedure under the Non Physician Provider? Also, does it make a difference depending on the payers [...]

2012 Physician Fee Schedule: Prep For ED E/M Coding Adjustments, Telehealth Coverage, and Other Changes   (December 2011)

Check these RVU changes to calculate your 2012 payments If you were hoping for a reprieve in 2012 from the recession cost pressures on EDs, the word is that you can expect an overall decrease of 1.5 percent in 2012 CMS payments. Read on for how this all breaks down and will affect your ED billing. 2012 Fee Schedule facts: The Centers for Medicare and Medicaid Services (CMS) released the Medicare Physician Fee Schedule Final [...]

The 2012 Conversion Factor Remains in Limbo   (December 2011)

2011 will conclude with a Medicare Conversion factor (the Medicare payment per RVU) of $33.9764. The Congressionally mandated SGR (Sustainable Growth Rate) formula remains active and with the expiration of the latest congressional “patch” on Dec.31, 2011, the 2012 CMS Physician Fee Schedule Final Rule published a conversion factor of $24.6712 representing a 27.4 percent cut to physician payments, says Michael A. Granovsky, MD, FACEP, CPC, President of LogixHealth, an ED coding and billing company [...]