Intubation Coding: Go With the Flow: 5 Tips Boost Your Common ED Airway Procedure Accuracy   (August 2011)

Seconds count with airway tube insertions, but take a few minutes to learn these important tips.
A frequent presenting problem in the emergency department is a patient having trouble breathing due to pulmonary disease, injury, or swelling of the throat tissues. You would typically report these encounters as high level ED visits or critical care because of the nature of the presenting problem, but you may also be able to report a procedure code if it [...]

Laceration Repairs: Wound Repairs of the Lips and Mouth: Have Your Papers in Order Before Crossing the Vermillion Border   (August 2011)

Understand the anatomical differences in the mouth repair codes to ethically maximize your revenue.
Wounds of the mouth can be tricky because of the sensitivity and delicate tissues involved, but also because of the cosmetic considerations of this highly visible area. The exact location and extent of the repair in question will determine which code to report for these common ED scenarios.
Todd Thomas, CPC, CCS-P, President of ERcoder, Inc. in Edmond, OK offers these tips for [...]

E/M Coding: Capture Prolonged Service Encounters in the ED With These Tactics   (August 2011)

Tip: Read the fine print before assigning code 99354.
A frequent question among emergency department coders is how to capture ED visits that extended longer than the average visit. Although you may be tempted to report the prolonged service add-on codes, such as 99354 (Prolonged physician service in the office or other outpatient setting requiring direct [face-to-face] patient contact beyond the usual service; first hour [List separately in addition to code for office or other outpatient [...]

You Be the Coder: Look within before assigning a penetrating trauma code   (August 2011)

Question: A patient presents to the emergency department after he cut the tip of his finger off while removing the grass catching attachment from his lawnmower. In addition to the E/M documentation, the chart notes read as follows: “13:51 Hemostasis: Moderate amount of left phalanx of 3rd and 4th digits. Controlled using cauterization of both digital arteries of 4th digit, gel foam. Bleeding stopped.” Can I report code 20103 for this service?Alabama Subscriber
Answer: Code 20103 [...]

Reader Question: Not Every Pain in the Rear is a Pilonidal Cyst   (August 2011)

Question: Can you help me with CPT® code assignment for this procedure? The chart note reads: Exam reveals an abscess on the buttocks. The skin overlying the abscess was cleaned with Betadine x 3, anesthetized with 1% 3 cc xylocaine with epinephrine. The abscess was incised with a 15 blade and was productive of purulent fluid. Approximately 2 cc of pus was expressed from the abscess. A wound culture was done. The wound was then [...]

Reader Question: Select Code By Freestanding ED vs. Urgent Care Designation   (August 2011)

Question: Our group just started staffing a free standing ED. What place of service should I use for those ED claims?
Florida Subscriber
Answer: It depends on whether the facility is really an ED or actually an urgent care center. If it is licensed as an emergency department, use corresponding place of service code 23. Otherwise, use place of service code 20 for Urgent Care, which is defined as a location, distinct from a hospital emergency room, [...]

Reader Question: Identify Acute or Obstructive For COPD With Bronchitis   (August 2011)

Question: Can someone tell me what diagnosis code would be appropriate for COPD with bronchitis?
Nebraska Subscriber
Answer: The correct code choice will de driven by the precise diagnostic information available. If the chart documentation does not state acute bronchitis, the code would be 491.20 (Obstructive chronic bronchitis; without exacerbation). Other possibilities are 491.21 (Obstructive chronic bronchitis; with [acute] exacerbation) or 491.22 (Obstructive chronic bronchitis; with acute bronchitis) if the chart provides that level of detail. As [...]

Coding Strategies: Make Sure Your Wound Recheck Policy is All Sewn Up for Accurate Coding   (July 2011)

Medicare changes to the simple repair codes will cost you money, unless you know these tips.
You’ve probably noticed lower 2011 payments for simple laceration repairs (CPT® codes 12001-12018) since follow-up care in the ED is no longer included as part of these services. Staying extra vigilant about the assigned Medicare global period can help you recoup full deserved payment for these frequently-performed procedures.
Background: Medicare changed the payment policy for simple laceration repairs for 2011 by [...]

Coding Tools: Sample ED Relevant 2011 CPT® Codes with Reduced Global Surgical Package Days   (July 2011)

Keep this chart handy to help you master the 2011 global changes to some frequently-used codes. 

Audit Tips: Are Your Frequency Distribution Comparisons “Apples to Apples”? Avoid Outlier Designation With This Crucial Advice   (July 2011)

Use these tips to defend your distribution.
Payer expectations for a normal ED distribution can target your practice for audits, but applying such tactics as asking auditors to provide comparison details can help promote your cause.
Here’s the scoop. One way payers routinely identify providers for audits is by comparing the frequency distribution of their E/M codes to a broad standard of other providers. Frequency distribution just means tracking the utilization of each code in question as [...]