Reader Question: (Nearly) Dead Men Tell No Tales: Apply History Exemption Caveat for Critical Care   (October 2011)

Question: If a patient comes to the ED in critical condition and is not able to give a history, can we apply a caveat? Does that caveat also apply to physical exam or does the doctor need to perform and document a physical exam? West Virginia Subscriber Answer: If the patient qualifies for critical care, code 99291 (Critical care, evaluation and management of the critically ill or critically injured patient; first 30-74 minutes) [...]

Reader Question: In The Midnight Hour: How To Report An ED Visit That Transcends The Calendar Date   (October 2011)

Question: On what day do I report an ED visit when the patient arrives and physician treatment begins at 11:30 PM on Monday but the emergency physician does not complete their full evaluation until after midnight on Tuesday morning? Kentucky Subscriber Answer: Emergency department visits by nature are unscheduled and can begin at any hour of the day. As such it is not unusual for an ED visit to begin in the evening of [...]

ICD-9 Update: Adjust Your 2012 Dx Coding for Dementia, Influenza, and Anaphylactic Reactions   (September 2011)

Consider these new diagnosis codes to best capture your ED services. Although everyone is anticipating the transition to ICD-10 in October of 2013, we can’t forget about some key updates to ICD-9 2012 that take affect Oct. 1 that will affect your ED claims. Resource: A file providing complete information on 2012 changes to the diagnosis part of ICD-9-CM is posted on CMS’s webpage at https://www.cms.gov/icd9providerdiagnosticcodes/07_summarytables.asp. Heed Dementia Adjustments To illustrate, consider these ICD-9 code [...]

E/M Coding: Is There a Doctor in the House? Take This Primer on Reporting “In-house” Services   (September 2011)

4 tips help you select the right code to describe services provided outside the emergency department. Emergency physicians can be called out of the ED to attend to patients elsewhere in the hospital. Sometimes, especially in rural areas, the emergency physician is the only doctor in the hospital after hours to treat emergent or urgent problems such as falls or patients who code. Because these services are provided outside of the emergency department, the ED [...]

Typical Floor Service Procedures:   (September 2011)

Intubation: 31500 (Intubation, endotracheal, emergency procedure)Central Line: 36556 (Insertion of non-tunneled centrally inserted central venous catheter; age 5 years or older)CPR: 92950 (Cardiopulmonary resuscitation [e.g., in cardiac arrest])Chest tube insertion: 32551 (Tube thoracostomy, includes water seal [e.g., for abscess, hemothorax, empyema], when performed [separate procedure])Epistaxis treatment:30901 (Control nasal hemorrhage, anterior, simple [limited cautery and/or packing] any method) 30903 (Control nasal hemorrhage, anterior, complex [extensive cautery and/or packing] any method) 30905 (Control nasal hemorrhage, posterior, with [...]

Behavior Modification Codes: Calling for an Intervention: Get a Grip on Your Behavior Modification Services Coding   (September 2011)

Analyze the coding and reimbursement environment before assigning codes for smoking or substance abuse counseling.While a busy emergency department is not the ideal venue for lengthy preventive care counseling sessions, but it can present a good opportunity to have a discussion about contributing factors that may have brought a patient to the ED for treatment. Following the advice below to ensure any behavior modification service your ED physician provides gets properly reported.For example: Consider a [...]

You Be the Coder: Wound Repair Qualifies for Subsequent Hospital Care   (September 2011)

Question: An emergency physician is called to the inpatient setting by a floor nurse to care for an 84-year-old woman who was found on the floor near her bed. She suffered a 1.5 cm cut above her right eye. After a problem focused H&P, he determines the fall was simply caused by her getting tripped up by the sheets in the bed rail as she was going to the bathroom. The patient appears flustered and [...]

Reader Question: Listen Carefully For How To Report Ear Blockage Removal   (September 2011)

Question: Is irrigation of the ear canal included in the E/M or a separately billable procedure? Louisiana SubscriberAnswer: If only irrigation is performed, then it would be included in the E/M service. Use of code 69210 (Removal impacted cerumen [separate procedure], 1 or both ears), requires that the cerumen be impacted and removed using an otoscope and instruments such as wax curettes or suction. In the July 2005 CPT® Assistant, the AAO-HNS approved definition is [...]

Reader Question: External Vs. Internal Abscess Will Determine I&D Code Choice   (September 2011)

Question: Can anyone tell me the correct CPT® code for an I & D of a knee abscess? I am confused on whether it should be 10060, 10061 or 20600-20610. How do I determine which set of codes to use? Indiana SubscriberAnswer: You would report codes 10060 (Incision and drainage of abscess [e.g., carbuncle, suppurative hidradenitis, cutaneous or subcutaneous abscess, cyst, furuncle, or paronychia]; simple or single) or 10061 (Incision and drainage of abscess [e.g., [...]

Reader Question: Assign Physical exam Organ System By Statement Context   (September 2011)

Question: Using 1995 guidelines, in which organ system would this fall for a PE element? “Neck: Normal range of motion. Neck supple.” Would you count this as Musculoskeletal. or Lymphatic?Answer: This common physical exam notation will not always be assigned to the same organ system. In general, proper allocation to a physical exam body area or organ system will depend upon the context in which the statement is made. The comment” neck supple”, implies a [...]