Last month’s issue of ED Coding and Reimbursement Alert reported on the 2012 CPT® updates relevant to emergency medicine, but the just released CPT® 2012 errata file added the subsequent observation codes (99224-99226) to the code range parenthetical for use with prolonged service codes. This accounts for the typical times listed in the code descriptors for the subsequent observation codes. The revised code descriptor and applicable code range now appears as follows:Code 99356 (Prolonged physician [...]
Audit Proof Your History Component Coding Selections: Here’s How (December 2011)
See this advice on using “Non-contributory” to document a ROS of past, family, social history.ED coders frequently wrestle with whether the documented phrase “non-contributory” for a history element satisfies the documentation requirements. The good news is help is here; read on for advice on solving this conundrum:The challenge: Does “non-contributory” indicate that the physician inquired about those elements and there was nothing about the response that contributed to the current presentation, or does it mean [...]
ICD-9 Coding: Ring in the New Year with a Refresher of Alcohol Related Diagnoses (December 2011)
Make sure you select the right diagnosis code when alcohol is a factor an ED visitThe New Year is upon us and with it comes an increase in alcohol-related presentations to the ED. Although many presenting problems are injuries or illnesses to which alcohol was a contributing factor, it may be worth reviewing the various alcohol-related diagnoses that are available and when to apply them in the ED setting. Take a look at some common [...]
You Be the Coder: Don’t Be Shocked; Is This Cardioversion or Defibrillation? (December 2011)
Question: How would you code the following scenario? A78 year-old-male presents to the ED after suffering cardiac arrest. The medics had regained vital signs initially in route to the hospital but upon entering the ED, the patient “codes”. The initial rhythm is noted to be ventricular fibrillation. The patient is defibrillated several times with escalating levels of electricity, and upon the 3rd attempt converts to normal sinus rhythm. At this point, the patient is intubated and rushed [...]
Reader Question: Can two emergency physicians both report critical care? (December 2011)
Question: A critically ill patient was seen by one emergency physician who documented 91 minutes of critical care time. Later that afternoon, a second emergency physician was asked to see the patient for hypotension, started a central line and documented 60 minutes of critical care time of his own. Do I add the critical care services together for the first physician and give the second physician credit for the procedure, or should I just report [...]
Reader Question: Consider Patient Age For Critical Care Transport (December 2011)
Question: Is anyone billing procedure codes for an emergency physician who rides with a patient from one ED to another, either via ambulance or helicopter? This is a new area that we are starting to see more often and we have no idea if there are such codes…any help would be greatly appreciated! Oklahoma SubscriberAnswer: If the physician is providing critical care services during patient transport, you would report that service for the time spent. [...]
And check out new guidance on wound, burn and ultrasound services that could affect your revenue. ED coders can look to the E/M section of their 2012 CPT® manual for most of the relevant changes and additions. But beware: Most of these are subtle references to time in applicable E/M code ranges, often hidden in preambles and parenthetical references that are easy to miss. Read on for guidance on identifying the ED specific changes that [...]
Review these tips to fully understand how CCI impacts your code selection.Write a simple catchy lead sentence that summarizes the challenge with CCI for ED coders. Make this really ED-focused. What’s CCI? National Correct Coding Initiative (CCI) policies were established by The Centers for Medicare and Medicaid Services (CMS) based on coding conventions that are defined in the AMA’s CPT® manual, local and national policies and edits, guidelines developed by national societies, analysis of standard [...]
Reviewing Edit Information on CMS: A Few Pointers (November 2011)
Check these time saving tips on using the CMS site for reviewing edits.Where to look: The official edit tables can be found on the CMS website at http://www.cms.gov/NationalCorrectCodInitED. The tables may be downloaded and viewed or saved. Users should be aware that if a file is saved, the data is only appropriate for the current quarter, warns Todt. How to search: When reviewing the CCI file for a specific edit, the user will need to [...]
You Be the Coder: What are the rules for physical presence in a teaching setting? (November 2011)
Question: We are getting a lot of feedback that our emergency physician faculty members, who are supervising residents, can’t report procedures that allow “supervision of key components.” Rather, we are told that they must remain at the bedside the entire time in order to bill for the procedure. For many procedures, this isn’t a problem, but watching a 1st year resident sew up a 15cm laceration for an hour isn’t practical in a busy ED. [...]
