Reader Question: New FAST   (January 2001)

Question: One of our ED physicians has been doing ultrasounds on trauma patients. He said it is called FAST (Focused Assessment with Sonography for Trauma) and wants to know how to charge for it. Its a combination of abbreviated ultrasound exams to the abdomen, liver, spleen, pelvis and pericardium. Do you have any information about this? Ohio Subscriber Answer: Many physicians are doing FAST exams on a research-only basis and are not billing for them. [...]

Reader Question: Coding for Hernia   (January 2001)

Question: Is there a CPT code for inguinal hernia reduction performed in the ED under conscious sedation? Also, our doctor reduced an umbilical hernia in the ED (the patient is 42 years old). Is there a CPT code for that or just the evaluation and management (E/M)? Would it be appropriate to use 49585 as the surgical code?Washington Subscriber Answer: There is no code for hernia reduction. It is rolled into the evaluation and management (E/M) [...]

Know Your Carriers Policy to Avoid Errors When You Bill for a Splint Applied by a Nurse or Technician   (December 2000)

To ensure correct coding for the application of a splint by the emergency department (ED) physician, coders must check with their local carriers to determine what documentation is needed to bill for a splint if a physician orders it and then a nurse or technician applies the splint. Many coders believe that splinting codes 29105 (application of long arm splint [shoulder to hand]), 29125 (application of short arm splint [forearm to hand]; static), 28126 ( dynamic), [...]

News Brief: HHS OIG Targets Critical Care Codes in 2001 Work Plan   (December 2000)

The Department of Health and Human Services Office of Inspector General (OIG) has released its work plan for fiscal year 2001. The work plan points out the areas the OIG will be looking at for strict enforcement, including areas it will audit to make sure the billing is correct. New to the work plan is a focus on the following: Critical care codes (99291-99292): Vital to the emergency department (ED), critical care codes (99291, critical [...]

Medicare Increases Fees to ED Physicians for 2001   (December 2000)

In the Nov. 1, 2000, Federal Register final rule for revisions to payment policies under the 2001 Physician Fee Schedule, HCFA has introduced a 4.5 percent overall increase in payments to physicians for Medicare Part B services. The 2001 fee schedule conversion factor has increased to $38.2581. The separate 2001 national average anesthesia conversion factor is $17.26. The final rule lists individual relative value units (RVUs) for each individual CPT and HCPCS code, and outlines [...]

You Be the Coder: Lacerations in the ED   (December 2000)

Question: Is it correct to code an evaluation and management (E/M) code for all lacerations seen in the emergency department?Massachusetts SubscriberTest your coding knowledge. Determine how you would code this situation before looking at the box below for the answer.

Answer: All lacerations billed to Medicare should include an evaluation and management (E/M) service. Other carriers wont accept an E/M code with a laceration. When submitting an E/M service with a laceration, the documentation must [...]

Reader Question: Starred Procedures   (December 2000)

Question: Please explain a starred procedure and how it would affect billing that procedure when performed in the emergency department. Also, what does not billing starred mean in the same instance, especially now with APCs? Warren CooperThomasville, Ga. Answer: Starred procedures are surgical procedures that do not include preoperative and postoperative packaging in the cost of the procedure. When the starred (*) procedure is carried out at the time of an initial visit (new patient) and [...]

Reader Question: When Length is Not Available   (December 2000)

Question: A patient arrives in the emergency department with a crush injury to a finger: the bone is visible and uncovered. Soft tissue is displaced and there are multiple lacerations/macerations. The provider performed debridement and was able to cover the bone completely with soft tissue fragments. How is this procedure coded when a total sum of length is not really available? Ohio Subscriber Answer: When the documentation does not have enough information to determine a [...]

Reader Question: Waiving of Coinsurance   (December 2000)

Question: I know that Medicare considers the routine waiver of coinsurance or deductibles an unlawful practice. It is my understanding that this is also unlawful for other commercial payers. Can you refer me to a written resource? Jan Loomis, CPCTeamHealth West, Pleasanton, Calif. Answer: Technically, with all health plans, it would be violating the contract provisions between the patient/health plan and, if participating with that health plan, the group/health plan. The group signs an agreement [...]

Reader Question: Two Nosebleeds, One Day   (December 2000)

Question: A patient is seen in the emergency department at 6 a.m. for a nosebleed. Cautery was performed, and the patient was released. The patient returned at 10 p.m. for a nosebleed after using cocaine, and cautery was performed again. Can both visits be billed separately? Or does this apply to the provisions of only billing one visit on the same day? Sue Fronczek Medical Management Solutions Inc., Cherry Hill, N.J. Answer: If you have a [...]