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Emergency Department Coding & Reimbursement Alert

2016 Medicare PFS Final Rule Update:
Expect Conversion Factor, Care Planning, and PQRS Changes for Your Practice
Overall, ED payments should remain similar to what you got in 2015 If you're not interest... Read more
2016 Physician Fee Schedule:
Check Out Table 63: See What Your Payment Will Be for These ED Procedures
Most facility E/M codes will see about a 1 percent decrease in 2016  ... Read more
ICD-10 Coding:
Watch Your Step When Assigning Diagnosis Codes for Falls
Read the rules about including Z codes describing a risk or history of falling ICD-10 ... Read more
Reader Question:
Nature of the Presenting Problem Must be Considered, Not Just the Key Elements For E/M Codes
Question: Our internal auditors are telling me I’m not coding high enough on ... Read more
You Be the Coder:
There Is No Margin For Error When Measuring Lesion Excision Sites
Question: When the ED physician removes a benign lesion, how should I measure the e... Read more
2016 CPT® Changes:
Prep For New Prolonged Service, Radiology, and Immunization Codes in 2016
The 2016 CPT® book added 140 new codes, revised an additional 134 more and deleted 92 pri... Read more
Influenza Update:
Don''t Let ICD-10 Influenza Coding Make You Sick
Check out these tips on coding those influenza presentations in the ED Now that the im... Read more
Vaccine Payments:
Use This Handy Chart For Medicare Part B Flu Vaccine 2015-2016 Payments
Medicare has released its payments for influenza and pneumococcal vaccines administered th... Read more
Reader Question:
Use This Feedback to Improve Your Behavior Modification Coding
Question: Can we report services involving behavior modification counseling in the ED... Read more
Reader Question:
Can You Report Moderate Sedation Codes Along with RSI?
Question: When a patient has rapid sequence intubation (RSI), can moderate sedation... Read more
Reader Question:
Check The Global Period Before Reporting A Follow Up Visit On Laceration Repair
Question: We saw a patient with a laceration that was repaired using a simple singl... Read more
Reader Question:
Measure Twice, Cut Once With Lesion Excision Sites
Question: When the ED physician removes a benign lesion, how should I measure the e... Read more
You Be the Coder:
Check for Catheter Use Before Coding Thoracentesis
Question: A patient with shortness of breath reports to the ED. The physician obtai... Read more
Observation Care:
Did You NOTICE The New Law Covering Observation Patients?
Written notice to patients to be required under observation status in 2016. If you wer... Read more
Kudos to the QIOs
You’ll be getting medical reviews from a new entity for 2016. CMS has proposed to ... Read more
Burn Coding:
Cozy Up To The Fire And Read Up On The Rules For Burn Coding
Chart documentation will guide the proper code choice to describe your burn care. As the ... Read more
Burn Code Calculator:
Track Your Burn Code Pay With This Handy Reference
Payments increase significantly with higher level burn code assignments Check out this... Read more
Place of Service Codes:
Apply New Place of Service Code 19 For Off Campus Hospital Services
Provider-based settings away from hospitals to get their own POS code in 2016. Although t... Read more
You Be the Coder:
Be Alert For Chart Documentation To Determine The Correct Moderate Sedation Code
Question: HPI A 12 y.o. female presents to the ED via EMS complaining of fall and arm inj... Read more
Time Is Up! ICD-10 Implementation Starts in October
Good news:  CMS will be flexible on absolute accuracy in your code assignments. I... Read more
Grab These Last Minute Resources
CMS is trying to ease the transition with education and helpful resources. A website htt... Read more
Observation Codes:
Look Through Observation Transparency Concerns To Be Sure You Select The Correct Code
Review these code descriptors to avoid compliance problems under close scrutiny When i... Read more
Reader Questions:
Don't Let the Wrong Code Choice Block Your Pain Control
Question: Can I bill for Digital Nerve Blocks? What about dental blocks in the ED s... Read more
Reader Questions:
Wake Up To Appendix G Language For Accurate Moderate Sedation Coding
Question: I have a question regarding the use of the 99148-99150 code. In our pract... Read more
You Be the Coder:
Look Beneath The Surface Before Reporting A Penetrating Trauma Code
Question: A patient presents to the emergency department after he cut the tip of hi... Read more
Pediatric Coding:
Do Your Homework On How To Correctly Document Pediatric ED Visits
Watch for age specific codes and rules for common ED services like moderate sedation and b... Read more
ICD-10 Coding:
Apply These Laterality And Episode of Care Tips For Pediatric Presentation Diagnoses
Under ICD-10, you'll need to check the chart to correctly assign that 7th character for th... Read more
Reader Questions:
Take This Expert Advice, On Billing For Extra Consultation Time
Question: One of our physicians spent 30 minutes speaking with a suicidal patient a... Read more
Reader Questions:
My Payments For 31500 Are Going Down The Tube!
Question: I billed 99285-25 with 31500, but insurance has denied the claim saying 3... Read more
You Be the Coder:
Coding a Chart When The Minimum Time Threshold For Critical Care Seems Questionable
Question: We need help coding this chart when the minimum time threshold for critic... Read more
E/M Coding:
Documented H&P And NOPP Will Determine the Difference in Your Level 3 and Level 4 Claims
It’s not just about counting bullets anymore. If you’re like most ED coder... Read more
E/M Coding:
We Have to Stop Meeting Like This: How To Code For Repeat Patient ED Visits On The Same Day
Payer policy will likely determine the correct strategy Confused about the rules regar... Read more
Stop Reimbursement Leaks: Tighten Up Your Dx Coding for Genitourinary Presentations
Check out these tips on common ED GU presentations Acute kidney failure and its associ... Read more
Reader Questions:
Is It Critical For The Physician To Document A Full History For Code 99291?
Question:  Does the ED physician need to complete all the HPI, ROS, history, and exam... Read more
Reader Questions:
Resolve Coding Disagreement with Physician
Question:  We disagree with our emergency physician’s documented level of car... Read more
Reader Questions:
Clear Your Dental Nerve Block Claims
Question: A patient presents in the emergency department with a toothache. The ED p... Read more
You Be the Coder:
Check Sedation Level Achieved Before Assigning A Fecal Disimpaction Code
Question: We are wondering how to code for this fecal disimpaction encounter. The doc... Read more
Preparing for ICD-10 Implementation:
Fast Track Your ICD-10 Prep With 9 Strategies for ED Priority Diagnoses
Your choice of pain code will depend on the system where the pain occurs After much discu... Read more
Nasal Hemorrhage Procedures:
Stem the Flow Of Lost Revenue For Non-Active Nosebleeds
Check the chart carefully to see if a separate procedure is warranted for nose bleed pre... Read more
Reader Questions:
Include Diabetes Diagnosis Only If Condition Affects Current Treatment
Question: A patient with a plan of care in place for her type II diabetes reports t... Read more
Reader Questions:
Coude` This Be A Complex Catheter Placement?
Question: Is the routine placement of a plain Coudé catheter considered a si... Read more
Reader Questions:
Direct Your Cast From The Right Script When Applying Casting Reporting Rules
Question: A 9 year old presents to the ED for fracture of distal radius. ED physici... Read more
Reader Questions:
Make Your Nail Bed Repair Neatly With This Tip
Question: Can I get help with a procedure code for this nail bed repair? Note rea... Read more
You Be the Coder:
Don't Get Stuck On The Correct Code for Tissue Adhesives
Question: A 67-year-old woman presents after falling in her kitchen. She was feelin... Read more
Critical Care:
Review These Critical Care Bundling Rules to Ensure Your Code Choices Get Rave Reviews
Strategies get you ready for auditors’ critiques.  Critical care coding is ... Read more
Facility Coding:
Know These Rules for Emergency Department Facility Levels
Getting the facility payments right will help you keep your job there. CMS continues to h... Read more
SGR Update:
Congress Passes A SGR Fix Bill To Avert Formula Driven Cuts
Look for minimal payment updates and changes to incentive programs to help pay for the f... Read more
Reader Question:
Can You Bill For Acupuncture in the ED Setting?
Question: Our ED physician was asked by Dr. XX to see this patient and treat her fo... Read more
You Be the Coder:
Moderate Sedation and the Separation Repair
Question: A 14-year-old patient reports to the ED with an injured right shoulder. W... Read more
Ultrasound Coding:
Probe Carefully to Ethically Maximize Ultrasound Reimbursement
Diagnostic imaging services are under increased payer scrutiny. Learn these tips to make s... Read more
FBR Eye:
Look closely at the documentation for these clues to determine the right code.
Look closely at the documentation for these clues to determine the right code.  A... Read more
Reader Question:
Is This A Loose Interpretation Of A Laceration Repair?
Question:  Can you help us with this scenario? A patient arrives with a gaping woun... Read more
Reader Question:
Separate Documentation Key to Correct Modifier 25 Claim Coding
Question:  I am having trouble with my modifier 25 coding, specifically with my doc... Read more
Reader Question:
Take A Break To Get Support For Multiple Fracture Code Sequencing
Question:  A patient came into our ED with multiple fractures. How do I know which ... Read more
Reader Question:
Make Sure The Link Is Strong Before Counting Resident Documentation
Question: If no linking statement by the attending is present, which part of the residen... Read more
You Be the Coder:
Is It Really A Complex Repair? Check the Note to Verify it Matches the Physicians' Description of the Wound.
Question: There is no doubt about the significant injury to the toe in this scenario ... Read more
Audit Update:
Get Ready for RACs to Scrutinize Your Critical Care, Global Surgical Claims
RACS now have a shorter reporting period for findings and have more pressure to get thei... Read more
Unfavorable Audit? Don't Think Twice About Appealing
If you’ve taken a hit from RAC auditors, think twice before just writing a check f... Read more
Check out the chart showing the 5 levels of RAC appeals and the related filing deadlines.
This chart lays out the five levels of RAC appeals process. AIC in the chart refers to t... Read more
PQRS 2015:
Check Out The Emergency Medicine Reporting PQRS Cluster
Cluster 4 will significantly help emergency physicians successfully report to avoid pena... Read more
Reader Question:
Is It Critical To Have Two Diagnoses To Justify Both 99291 and 99292?
Question: One of our payers is taking back payment for 99291 and 99292 stating their rea... Read more
Reader Question:
Break Out the Professional EM Procedure for Fracture Care
Question: We are in the middle of a debate and need some help for both the facility... Read more
Reader Question:
Does Medicare Allow Residents to Use Scribes?
Question: We are debating using scribes for the residents to document.  I hear... Read more
You Be the Coder:
Can You Draw Elements of History and MDM From Anywhere In The Chart?
Question: The chart documentation seems a little brief, but this seems like a pretty ... Read more
Looking for Good News? CMS Rings in 2015 With Some RVU Raises
Downside: Increase also triggers a drop in the conversion factor. You’re getting... Read more
PQRS 2015 Medicare Final Rule:
Quality Provisions Highlights: Say Goodbye To PQRS Incentives
The penalties are getting bigger and some familiar performance measures may disappear ... Read more
Orthopedic Procedures:
Keep These Common Ortho Medical Terms Handy
Knowledge of terms can make coding less confusing Fracture care and orthopedic procedu... Read more
Behavior Modification Co:
Help Patients Keep Their New Year's Resolutions With Behavior Modification Services Coding
Make sure you know the rules before assigning codes for smoking or substance abuse couns... Read more
Reader Question:
Check Location Length and Layers When Assigning A Laceration Repair Code
Question: Can we report a complex laceration repair code use given this chart note?... Read more
Reader Question:
Do You Have to Be Family to Count as Family History?
Question: Would you consider “No sick contacts” acceptable for Family H... Read more
You Be the Coder:
Coding When ED Physician Calls In A Specialist
Question: A patient presents with a badly injured left ankle. During the course of a ... Read more
2015 OPPS Rule:
You Can Expect More Of The Same For 2015 Medicare Facility Payments
ED Facility Levels Don’t Collapse, But More Facility Payment Bundling Will Occur In ... Read more
Ebola Diagnosis: A Code You Hope You Never Need, But Should Know How to Report
Contact with and suspected exposure codes are also relevant in Ebola outbreaks Ebola V... Read more
Using Scribes in the ED:
Write This Down! Get the Latest News On Using Scribes In The ED
Take note of these rules when considering what the scribe can actually record The wide... Read more
Reader Question:
Watch Your Step When Coding For Foreign Body Removals From the Foot
Question: A patient with a splinter reported to the ED after walking barefoot on an o... Read more
You Be the Coder:
Not Every Sore Throat Is Low Level MDM Level Two: Code Carefully or More Than A Tongue Will Get Depressed
Question: How would you code the following patient presentation? Chief Complaint:... Read more