Reader Question: Consult Code Book For Foreign Body Removals From the Foot.   (November 2011)

Question: A patient with a splinter reported to the ED. After a level-two E/M, the physician uses a needle to make an incision and remove the splinter from the patient’s right foot. The insurer rejected 10120 as mismatching the diagnosis. Should I appeal the denial?North Dakota SubscriberAnswer: The problem may have been a mismatch between the CPT® procedure code and the ICD-9 diagnoses code on the claim. Before sending in a claim for foreign body [...]

Reader Question: Be specific with the diagnosis to show ECG Claim medical necessity   (November 2011)

Question: What codes should we use to report diagnostic electrocardiography (ECG) tests? And how can we prove medical necessity for these tests? We have gotten several recent “medically unnecessary” denials on ECG claims. Minnesota SubscriberAnswer: Emergency physicians often order ECGs based on presenting symptoms to determine whether the patient has a cardiac problem. Payment for this diagnostic test often depends on whether you can prove medical necessity. Choose an ICD-9 code that tells the payer [...]

Diagnostic Interpretations: Finesse Your EKG Interpretation Claims With This Can’t Miss Documentation Advice   (October 2011)

Does your chart include the required elements to stand up under audit? If you’re getting repeat denials when your ED physician interprets electrocardiograms [EKG], it’s time to stop and ask yourself some critical questions, including whether the documentation meets Medicare’s definition of interpretation and whether the notes clearly identify which ED provider did the interpreting and why the EKG was ordered. Reality: One of the most frequently reported non-E/M services in the emergency [...]

What Does Separately Identifiable Mean? Heed Medicare’s Advice on What Constitutes a Written Report   (October 2011)

Medicare states that the EKG interpretative report must be a complete written report similar to that usually prepared by a specialist in the field and should be consistent with the service furnished. Medicare policy also states an \”interpretation and report\” should address the current findings, relevant clinical issues, and comparative data when available. Discern Review from Interpreted Report A chart notation of \”EKG normal\” is deemed an insufficient interpretation and report and would [...]

Ultrasound Coding: Probe Carefully to Ethically Maximize Ultrasound Reimbursement   (October 2011)

Diagnostic imaging services are under increased payer scrutiny. Learn these tips to make sure your code choices are secure. More and more EDs are using ultrasound services for diagnosis, but ED coders may not be fully up to speed on reporting these quick and non-invasive visualizations. Take a close look at the advice that follows to get an easy-to-apply view of the requirements for successful ultrasound billing. Getting started: For diagnostic ultrasound codes, look [...]

Common ED Ultrasound Codes   (October 2011)

76536 Ultrasound, soft tissues of head and neck (e.g., thyroid, parathyroid, parotid), real time with image documentation 76604 Ultrasound, chest (includes mediastinum), real time with image documentation 76705 Ultrasound, abdominal, real time with image documentation; limited 76775 Ultrasound, retroperitoneal (e.g., renal, aorta, nodes), real time with image documentation; limited 76857 Ultrasound, pelvic (non-obstetric), real time with image documentation; limited 93308 Echocardiography, transthoracic, real-time with image documentation (2D), includes M-mode recording, when performed, [...]

Influenza Vaccine Coding: Look Sharp at New Vaccine Codes For The 2011 Flu Season   (October 2011)

Double check your code assignments to make sure you comply with payer instructions. Flu season can be a busy time in the emergency department, especially if an epidemic hits the area. Although ideally not the place for preventive care, your ED physician may provide flu shots for certain patient populations that seek treatment there. To better recoup deserved reimbursement for these services, take note of the differences between CPT® and Medicare for flu vaccine codes. [...]

You Be the Coder: Nail Down the Correct Code For This Finger Injury   (October 2011)

Question: What codes would your assign for the following chart note: Wound Repair of 1cm (0.4 in) involving nail bed laceration to dorsal aspect of distal phalanx of left middle finger. Irregularly shaped. Skin/tissue flap noted. Distal neuro/vascular/tendon intact. Anesthesia: Digital block administered with 4 mls of 1% lidocaine. Wound prep: Moderate cleansing with Betadine, Wound explored moderately, Copious irrigation. Subungal hematoma is drained. Nail avulsed fully and removed. Closed with 8 5-0 chromic [...]

Reader Question: Solve Nasal FBR Coding Dilemma   (October 2011)

Question: I’m a bit confused. When reporting a foreign body removal of the nose, would I use the CPT® code 30300? I also see an ICD-9 code for nasal foreign body removal of 98.12. I was told not to code the 30300 by one person, but then I was told I should code it by another. It was for an ER procedure. They used tweezers to remove a bead from a child’s nostril. New [...]

Reader Question: Can Pre-Hospital Direction To EMS Be Included In Critical Care Time?   (October 2011)

Question: Can you count the time a physician is involved in \”pre hospital care\” in critical care time? All I can really find is that the patient needs to be \”directly available to the physician.\” We have some controversy on this with the physicians that I am hoping to solve. Any help would be appreciated. Georgia Subscriber Answer: The critical care codes do have some pre-service time allocated in assigning their relative [...]