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Emergency Department Coding & Reimbursement Alert

Compliance:
OIG Begins Reviewing Critical Care Claims via Work Plan
 Auditors will soon start scrutinizing claims for critical care services. If you’v... Read more
Part B Stats:
Medicare Reviewers Reveal Issues They Found With Critical Care Claims
The results of this comparative billing report may surprise you. If our cover story makes... Read more
Consider An Internal Audit to Check Your Critical Care Processes
Many MACs are already reviewing these claims. If you’re worried about your critical car... Read more
Clip And Save:
Don't Forget The Services That Are Bundled into 99291 and +99292
The CPT® critical care preamble includes a specific list of services that are bundled in ... Read more
Reader Question:
Nail Down Pediatric CC Rules
Question: Our ED physician saw a critically ill pediatric patient yesterday but has never ... Read more
Reader Question:
CPR, Critical Care Can Be Reported Together
Question: A patient went into cardiac arrest in our ED waiting room. The physician perform... Read more
Reader Question:
Follow These Tips for Self-Audit Success
Question: We’re interested in performing a self-audit of our critical care claims but we... Read more
You Be the Coder:
Document Time Carefully With Multiple Physicians
Question: When two physicians of the same specialty and group practice provide critical ca... Read more
Part B Payment:
See How the Proposed 2019 Fee Schedule Could Impact Your ED
CMS proposes vast changes, but EDs are spared from the biggest impact. If you’ve heard ... Read more
Part B Payment:
Check These Proposed Changes to Quality Measures
Plus: What’s the proposed conversion factor for 2019? The proposed physician fee schedu... Read more
Bleeding Control:
Can You Answer These Bleeding Control FAQs?
From Minnesota tube to epistaxis control, test yourself on these scenarios. Emergency dep... Read more
Reader Question:
Know What Constitutes Primary Dx
Question: We saw a patient who presented for a COPD exacerbation and he went into acute re... Read more
Reader Question:
Know What Constitutes A Business Associate
Question: We recently hired a cloud storage outsourcing company for our medical records, a... Read more
Reader Question:
Combo Dx Deserves Two Codes
Question: What is the correct way to code for type 2 diabetes and a urinary tract infectio... Read more
Reader Question:
Keep Sequencing in Mind When Patient Has HIV
Question: The ED physician saw an HIV-positive patient for treatment of numerous chronic m... Read more
Reader Question:
Age Can Drive Venipuncture Codes
Question: I know that age is one of the factors that differentiates between the venipunctu... Read more
You Be the Coder:
Look to "T" Codes for Heatstroke Dx
Question: We have had more patients than usual who have presented for heatstroke, but we a... Read more
ICD-10:
You'll Find New Appendicitis, Ecstasy Poisoning Codes on Oct. 1
The 2019 diagnosis codes include over 300 additions. From time to time, every ED coder wi... Read more
Appeals:
Your Appeals May Rely on These 4 Essentials
Don’t underestimate the power speaking to insurers. As payers increasingly step up deni... Read more
Diagnosis Coding:
Can You Select the Diagnosis Codes for These ED Visits?
Hint: Not all pneumonia codes are in the pneumonia section of ICD-10. One of the most int... Read more
Reader Question:
Differentiate Arthrocentesis, Aspiration
Question: We report code 20600 (Arthrocentesis, aspiration and/or injection, small joint o... Read more
Reader Question:
Know Which Fracture Dx to Apply
Question: We have a patient who underwent a 3-view ankle X-ray for a left, displaced later... Read more
Reader Question:
Know the Code for Diaper Rash
Question: We had a parent present to the ED with her one-year-old son, and she suspected h... Read more
Reader Question:
Vermillion Repair? Look to 40650
Question: We recently repaired a laceration on the vermillion border of a patient’s lip.... Read more
Reader Question:
Get the Rhythm of 93040
Question: I am unsure about some of the ECG reporting rules. Could you please explain the ... Read more
Reader Question:
Could Texas Begin Denying "Non-Emergent" ED Visits?
Question: I read your article last month about Missouri’s efforts to curb Anthem’s pol... Read more
You Be the Coder:
Does This Constitute An Invalid Code?
Question: In your article last month, “Compare Your Claims Against This MAC’s Top Deni... Read more
Denials:
One State Aims to Quell Anthem's ED Denials
As complaints mount, states are taking issues into their own hands. As complaints continu... Read more
ICD-10:
Pinpoint Fracture Diagnoses With These Quick Tips
Hint: Osteoporotic fractures might not be coded from the fracture section. It's likely th... Read more
Claim Denials:
Compare Your Claims Against This MAC's Top Denial Reasons
Hint: Some codes have prerequisites before you can report them. Denials happen to every E... Read more
Reader Question:
Get the Scoop on Myositis Coding
Question: Our provider documented that a patient was suffering from pain, swelling, tender... Read more
Reader Question:
Crush Injury Dx Requires More Details
Question: The physician treated a patient for "crush injury, lower forearm." What ICD-10 c... Read more
Reader Question:
Which Code Applies to Splinter Removal?
Question: Our physician saw a patient who had been running barefoot on a wooden deck, whic... Read more
Reader Question:
Nail Down These Vent Management Rules
Question: What are we required to document when the physician administers ventilation mana... Read more
Reader Question:
Is MIPS Meaningful Use No More?
Question: Our ED just got a handle on the MIPS and other fairly new programs, and now our ... Read more
Reader Question:
Find out What to Do With PHI
Question: We are moving to a different location, and staff members are purging old patient... Read more
You Be the Coder:
Ensure Thorough Documentation for X-Rays
Question: The ED performed a four-view x-ray of a patient's left knee, including lateral a... Read more
Compliance:
Recent Medicare Audit Shows Where EDs Stand in Terms of Opioid Prescriptions
If your opioid prescription count is higher than average, don't panic, reps say. Many ED ... Read more
Denials:
Payers Issue Fresh Denials for Repeat Chest X-Rays, EKGs
Remember to use modifiers when necessary to denote medically necessary repeat tests. If y... Read more
ICD-10:
Prove Urine Test Medical Necessity With Accurate ICD-10 Codes
Your ED bills these services frequently, so pinpoint the right codes. When patients prese... Read more
Reader Question:
How to Prevent Mobile Device Issues
Question: Our staff members now carry tablets where they record their documentation. Twice... Read more
Reader Question:
Don't Forget Seventh Character for Fractures
Question: We treated a patient with multiple fractured ribs and we reported a six-characte... Read more
Reader Question:
Know the Keywords to Report Otitis Media Diagnoses
Question: We see a lot of ear infections in the ED, and often the physician will only docu... Read more
You Be the Coder:
Can You Code This COPD Diagnosis?
Question: A patient who has had COPD for nine years presented to our ED with serious diffi... Read more
Modifiers:
Last-Minute Change Saves Practices from Further Modifier 25 Pay Cuts
Tip: Use this as an opportunity to review your modifier 25 processes. Emergency departmen... Read more
Billing:
Perfect Your Medicare Secondary Payer Claims With These Tips
It's the practice's responsibility to know which payer to bill first, Part B rep says. Pi... Read more
Use This Chart to Determine Primary Payer
There are myriad situations that you may see when you have to determine whether Medicare i... Read more
ICD-10:
Heed These ED-Specific ICD-10 FAQs
From gastritis to conjunctivitis: These are the right diagnosis codes to use. Flu season ... Read more
Reader Question:
Heed This Laceration Repair, Debridement Advice
Question: We recently treated a patient who was involved in a skateboard accident, which r... Read more
Reader Question:
Remember to Sign Those Orders
Question: We have problems with one of our ED doctors who orders lab tests and doesn't sig... Read more
Reader Question:
Pinpoint the Myositis Code
Question: Our physician documented that a patient was suffering from pain, swelling, tende... Read more
Reader Question:
Does This Scenario Require More Information?
Question: A parent brought a newborn patient to the ED with nasal discharge, nasal swellin... Read more
You Be the Coder:
Which E/M Code Applies When ED Patient Becomes Inpatient?
Question: We saw a patient in the ED for a possible broken bone following a car accident. ... Read more
Documentation:
CMS Rethinks Its Policy on Students' E/M Documentation
New policy will be a plus for EDs nationwide. Every hospital-based staff member has seen ... Read more
E/M Coding:
Here's How to Determine When 99285 is Warranted
Tackle this confusing question by checking these documentation items. Does your doctor fe... Read more
ICD-10:
Can You Answer These ICD-10 Coding Questions?
Confirm medical necessity with a sharp diagnosis coding knowledge. As most ED coders are ... Read more
Reader Question:
Know How to Answer the SNF Question
Question: We saw a patient for 24 hours in the emergency department and two days in observ... Read more
Reader Question:
Know the Epistaxis Encounter Rules
Question: A 17-year-old patient presented to the ED after being hit in the face with a soc... Read more
Reader Question:
Consider Time When Selecting Breathing Treatment Codes
Question: Is it true that if the physician performs continuous inhalation treatment (94644... Read more
Reader Question:
Understand How to Code Multiple Eyelash Removals
Question: We saw a patient who complained of eye irritation and pain. She had several eyel... Read more
Reader Question:
Check Payer Policies Before Filing Appeals
Question: We performed imaging for a patient who had a complaint of abdominal pain, and we... Read more
You Be the Coder:
Differentiate Open, Closed Fractures
Question: How can we tell the difference between an open fracture and a closed fracture? ... Read more
ED Payments:
Anthem Extends Policy Denying "Inappropriate" ED Visits to 3 More States
Physician groups, lawmakers fight against expanded policy. Private insurer Anthem Blue Cr... Read more
Part B Payments:
CMS: ED Practitioners Log Among the Highest Improper Payment Rates
The agency says EDs improperly billed over $315 million to Part B. Emergency departments ... Read more
Patient Privacy:
CMS Lays out New Texting Guidelines — Are You at Risk?
CMS explicitly prohibits texting physician orders. Texting is such a ubiquitous form of c... Read more
Reader Question:
Avoid Modifier 25 for Multiple Procedures
Question: We performed a nail bed repair and an arm laceration repair during the same enco... Read more
Reader Question:
Use ICD-10's Supplementary Words to Your Advantage
Question: Our ED physician diagnosed a patient with a traumatic central perforation of the... Read more
Reader Question:
ICD-10 Offers More Than One GERD Dx
Question: A patient presented to our ED because of burning throat painand denied chest pai... Read more
Reader Question:
Multiple Dx Codes Aren't a Necessity for Modifier 25
Question: One of our physicians is of the belief that he must link any E/M encounter that ... Read more
Reader Question:
Differentiate Flu From Flu-Like Symptoms
Question: We have had a record number of patients coming to the ED with flu-like symp... Read more
You Be the Coder:
Count Muscles to Pinpoint TPI Code
Question: A patient reported to the ED complaining of spasming pain in her left calf. Afte... Read more
Benchmarking:
How Would Your 99285 Coding Stand up in An Audit?
Plus: Find out which states had the highest and lowest percentage of high-level ED claims.... Read more
Is Your State Among the Biggest Billers of 99285?
Although the average percentage of services billed with 99285 in the US was 55 percent dur... Read more
ICD-10 Quiz:
Can You Select the Right Dx Code for These Emergent Conditions?
Your ED may see these diagnoses frequently, but do you know how to report them? Every ED ... Read more
Patient Privacy:
Determine Whether New HIPAA Update Impacts Your Rights to Discuss Patients' Opioid Issues
Do you know who you can share this information with? As emergency department providers st... Read more
Reader Question:
Evaluate Coding Options for Consults Outside the ED
Question: A hospital attending physician needed our ED physician's opinion on an inpatient... Read more
Reader Question:
Do All Burns Require Burn Codes?
Question: A patient reported to the ED with her shoulders painfully burned after spending ... Read more
Reader Question:
Differentiate Viral Pinkeye From Allergic
Question: We saw a patient with pinkeye related to a specific virus, and we've never seen ... Read more
You Be the Coder:
Know What Constitutes An 'Inducement"
Question: We keep hearing that we should be more careful about which cases to bill as obse... Read more
2018 Payments:
CMS Delays Decision on Whether to Adjust E/M Pay for EDs
Plus: Payments have been set for the new codes that debut Jan. 1. When CMS published its ... Read more
Claim Submissions:
Avoid These 10 Mistakes When Submitting Claims to Medicare
Hint: Part B MACs even have a favorite font for your claim forms. When it comes to submit... Read more
Critical Care:
Pinpoint Accurate Critical Care Codes Every Time With 5 Quick Tips
Yes, you can administer critical care in the ED. As most ED coders know, critical care se... Read more
Reader Question:
Calculate Lesion Sizes With Accuracy
Question: Our ED physician removed a benign lesion and isn't sure how to calculate the exc... Read more
Reader Question:
Discover When ICD-10 PCS Applies
Question: Should we be capturing ICD-10-PCS codes in our emergency department? We currentl... Read more
Reader Question:
Does RADS Code As Asthma?
Question: An adolescent patient presented to our ED with asthma-like symptoms: coughing, w... Read more
You Be the Coder:
Which Code Applies to Split ED Service?
Question: A doctor in our emergency department removed nasal packs that a different doctor... Read more