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Emergency Department Coding & Reimbursement Alert

Medicare Physician Fee Schedule:
2017 Medicare Fee Schedule Brings Good News for Emergency Physicians
Look for an increase in intubation procedures while ED E/M codes remain stable. The 2017 ... Read more
Telehealth Rules for 2017:
CMS Adds New Place Of Service Modifier for Telehealth Services
New telehealth POS 2 code for distant site from where the patient is being treated. CMS h... Read more
2017 Physician Fee Schedule:
Keep These Charts Handy To Compare Your 2016 and 2017 RVUs For ED Services
Although there were some minor tweaks to the PE and PLI RVUS, the net impact rounds to zer... Read more
FBR Eye:
Check 3 Details When Coding Ocular Foreign Body Removals
Look closely at the documentation for these clues to determine the right code. Consider ... Read more
Reader Question:
Check the 2017 Chart for Time Requirements on Additional Units of Moderate Sedation
Question: I read in the November issue that the new moderate sedation codes require a... Read more
You Be the Coder:
Is This a Level 3 or a Level 4 ED E/M Service? Find Out
Question: Other coders and I disagree about this chart: ED NOTE: CHIEF COMPLAINT/RE... Read more
2017 CPT® Codes:
Moderate Sedation Among Biggest Changes for EM In CPT® 2017
Watch for shorter time thresholds. There will be 727 changes to the CPT® code set ... Read more
Telemedicine modifier:
CPT® Adds New Modifier 95 To Capture Synchronous Telemedicine Services
Watch Appendix P for applicable codes. How CPT® should capture and report telemedicin... Read more
MACRA Implementation:
CMS Announces Relaxed Implementation Plans for the Quality Payment Program in 2017
Called Pick Your Pace, CMS Outlines Four Options Andy Slavitt, the acting administra... Read more
Revive Your Reimbursement For CPR Services With These Tips
What are the time requirements associated with CPT® Code 92950? Cardiopulmonary resuscit... Read more
Reader Question:
Learn The Rules of the Road For Reporting Transport Services
Question: Can we bill for care provided while patients are being transported by EMS... Read more
You Be the Coder:
Can You Invoke The Acuity Caveat for a Critical Care Case?
Question: Does invoking the ED acuity caveat impact assigning critical care for the... Read more
ICD-10 Coding:
Are You Ready For the End of the CMS ICD-10 Grace Period?
Check out these ED-relevant unspecified codes to prevent future denials. October 1, 20... Read more
Fracture Care:
Don't be Manipulated Into Reporting Just an E/M and Cast Code
Heal your reimbursement with these strategies Choosing the right fracture or dislocati... Read more
Reader Question:
Don't Count on CMS to Guide Facility Level Selection
Question: Does CMS have documentation guidelines for the facility level of ED servi... Read more
Grace Period Expected to End in Oct. 2016, So Be Ready
Check out these new ED-related 2017 ICD-10 updates for emergency medicine The freeze ... Read more
Recent Supreme Court Ruling Expands Reach of the False Claim Act
Does an improper licensed provider submission constitute a false claim under the law? The... Read more
2017 NPRM:
CMS Is Looking at the Values for Zero-Day Global Codes Billed with an E/M Service
Wound repairs, eye FBRs and intubation procedures are among the common ED procedures und... Read more
Common ED Services Found In TABLE 7 from the 2017 Proposed Rule:
0-day Global Services Typically Billed with an E/M Service with Modifier 25
Repair Codes 12001 (Simple repair of superficial wounds of scalp, neck, axillae, externa... Read more
Reader Question:
Check Medical Necessity, Calendar for ED Observation Services that Transcend Midnight
Question: We have a patient that presented to the ED at 10 pm on day one and after ex... Read more
Reader Question:
Don't Cast Too Wide a Net on "Incident To" Cast Applications
Question: A 60 year-old presents to the ED and is found to have a fracture of the d... Read more
Reader Question:
Check Two CPT Chapters to Code For A FAST Exam
Question: I have a chart that indicates that the ED physician treated a patient with ... Read more
You Be the Coder:
Review the Rules Before Assigning Laceration Repairs and Moderate Sedation Codes
Question: I am having trouble with the chart below. What codes should I use to report... Read more
2017 Medicare Proposed Rule:
Get A First Look at Next Year's Proposed Payments for ED Services
Expect new codes for moderate sedation and complex care coordination payments The propos... Read more
Zika Update:
Medicare Releases Coverage Instructions On Diagnostic Testing for Zika Virus
Documentation must show why the Zika testing was necessary. Testing for Zika virus is now... Read more
Laceration Repair Coding:
Use These Five Tips To Repair Any Wound Closure Claim Concerns
Note location, length, and type of repair to get the code choice right CPT® includ... Read more
Consider these clinical examples to help decide when to combine repairs or report them separately
Watch for locations and classification before choosing your code. The following wound ... Read more
Reader Question:
Gee, Do You See A GC Modifier Application Here?
Question: Do we need a GC modifier on our teaching physician claims? Oklahoma Sub... Read more
Reader Question:
Choose Only One Code for Multiple Observation Providers on the Same Day
Question: I have a question on a chart that indicates two of our emergency physicia... Read more
You Be the Coder:
Apply Those Repair Coding Tips to this Clinical Example
Question: Double check code descriptors for complex repairs Scenario: A patient w... Read more
Burn Coding:
Check Out these Four Hot Tips to Help with Your Burn Coding
Chart documentation guides the proper code choice to describe your burn care. Summer is h... Read more
Track Your 2016 Burn Code Payments With This Handy Reference
Payments increase significantly with higher level burn code assignments Check out this... Read more
Burn Diagnosis Coding:
Stop, Drop Your ICD-9 Book, and Roll with the ICD-10 Codes for Reporting Burns
Look for Total Body Surface Area (TBSA) documentation in notes. Look for three things ... Read more
Difference in Burn Coding ICD-9 to ICD-10
ICD-9: Burns and Corrosions Classifications: Body Site Depth     ... Read more
Reader Question:
Scope it Out: Can You Report Supervising A Resident From Another Specialty?
Question: If an Orthopedic resident comes to the ED and reduces a fracture while my... Read more
You Be the Coder:
Modify Your Fracture Care Coding To Provide The Exact Scope Of Services Provided
Question: A 9-year-old boy reports to the ED with his mother; the mother says the c... Read more
ICD-10 Coding:
Jump These ICD-10 Coding Hurdles for Geriatric Patients in the ED
Invoke the CPT® history caveat if the patient is not able to offer a reliable history Th... Read more
MACRA Proposed Rule:
MACRA, MIPS and APMs: The Proposed Rule Offers A Peek Into Future Reporting Requirements
Look for new names for PQRS, Meaningful Use and the Value Based Modifier Programs. The C... Read more
How Does MIPS Scoring Work?
There are four MIPS performance categories with their proposed weighting in 2017. Each... Read more
Participating In A Qualified APM Could Exempt You From MIPS Participation
You could also earn a 5 percent bonus for successful APM participation. The MACRA propose... Read more
You Be the Coder:
Is That Physical Exam Element an Organ System or a Body Area?
Question: Sometimes I’m coding a chart and can’t decide how to classify... Read more
Advance Care Planning:
Learn the ABCs of Using the ACP Codes in the ED Setting
Documentation, diagnosis and duration are all covered in this informative release The Cen... Read more
ICD-10 Coding for Zika Virus:
Is Your ED Ready For A Zika Outbreak?
Zone in on the terminology and symptoms that will help you code accurately ICD-10 Focus: ... Read more
Reader Question:
Would You Seal The Deal In Reporting WoundSeal as a Procedure?
Question: I’m starting to see mention of use of a product called WoundSeal in... Read more
Reader Question:
Can We Report Both ED And Hospitalist Services?
Question: My group has been asked to begin providing hospitalist services in additi... Read more
You Be the Coder:
Attestation Statements Hold the Key to Accurate Billing
Questions: This chart is causing arguments among my coders over what E/M code to re... Read more
Ultrasound Coding:
Make Sure There Is a Clear View of Your Documentation to Support Ultrasound Studies
Extent of the exam, medical necessity and an archived image are all required to secure pay... Read more
Critical Care:
Double Check Your Time Statement before Assigning a Critical Care Code
Verify your time attestation statement for the best results. Critical care coding is an e... Read more
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 bundle... Read more
Reader Question:
Breathe Easy When You Know the Payment Policy for Pulse Oximetry
Question: Can we bill for a pulse oximetry? I’ve heard it both ways. What abo... Read more
Reader Question:
Don't Cause an Incident by Billing for Cast Application Without Physician Involvement
Question: A 10 year old presents to the ED for fracture of distal radius. ED physic... Read more
You Be the Coder:
Nail It Down Or Sew It Up? How Do You Code an injury to the Fingernail Area?
Question: Should I report this as a nailbed repair or use a laceration repair code?... Read more
Quality Reporting:
The SGR Is Finally Gone But MIPS Takes Its Place
Along with several new acronyms like VBM and MAV you'll need to know When the Medicare Ac... Read more
PQRS Specifications for Measure 317
Measure #317: Preventive Care and Screening: Screening for High Blood Pressure and Follo... Read more
Medicare Conversion Factor:
CMS Makes A Small Technical Correction to the 2016 Conversion Factor
Every penny counts when calculating your Medicare payments The Centers for Medicare &... Read more
Laceration Repairs of the Mouth:
Pay More Than Lip Service to Coding Rules For Mouth Lacerations
Depth of the injury and closure method chosen will drive correct code choice Due to ge... Read more
Reader Question:
It Might Sting A Bit If A Large Bill Is Received for "Just A Shot"
Question: If a patient presents to the ED for just a tetanus shot, can you also rep... Read more
Reader Question:
Location And Extent Of Closure Are Key When Coding Oral Laceration Repairs
Question: Should I be coding an intermediate repair (12011) for a laceration in a p... Read more
Reader Question:
Don't Misstep When Dealing with Tarsal Fractures
Question: We had a patient present with a non-displaced tarsal bone fracture, which... Read more
Reader Question:
Get the Inside Look At Ultrasound Documentation Requirements
Question: Can we get paid for coding and billing for ultrasound services?  Spe... Read more
You Be the Coder:
Look for Documentation of Catheter Use Before Coding Thoracentesis
Question: A patient with shortness of breath reports to the ED. The physician docum... Read more
Cardioversion Tips:
Charge Up Your Cardioversion And Defibrillation Coding With These Tactics
Can you identify the difference in these procedures to code accurately and prevent denials... Read more
2016 RVUs and Medicare Payments for Cardioversion and Related Codes
92960 (Cardioversion, elective, electrical conversion of arrhythmia; external) has a wor... Read more
EMR Attestation Compliance:
Know When And Where To Use Attestations In Your ED Charts To Stay Out Of Trouble
Shortcuts can help -- but beware of these audit pitfalls.  Electronic Medical Recor... Read more
Reader Question:
Watch the Clock When Reporting Both Critical Care and CPR
Question: One of our physicians documented critical care time on a patient where CP... Read more
You Be the Coder:
That Middle Finger Injury Could Be No Joking Matter
Question: Review this case of a presentation for a finger injury and check your cod... Read more
OPPS Update:
Expect to See More Bundling with Overall Lower Payments in 2016
OPPS conversion factor drops, but individual APC payments changes will vary. The Centers ... Read more
APC Packaging:
Ancillary Services and Clinical Diagnostic Tests will Be Bundled with Minor Procedures
Assigned status indicator will determine what will be paid separately CMS has again incre... Read more
Payment Thresholds in Place for Pass Through Drugs
For 2016, a hospital will be eligible for an outlier payment if its cost of furnishing a s... Read more
OPPS Procedure Payments:
Review These 2016 Procedure Payment Changes
Some Increase While Others Drop Based On Status Indicator Assignment While all the 201... Read more
ICD-10 Coding:
Scope Out These Tips on ICD-10 Coding For ED OB GYN Presentation
Do you know the “N” and “O” codes that pertain to these systems?... Read more
Reader Question:
Is Femoral Line Placement Bundled into Critical Care?
Question: A 22-year-old motor-vehicle accident victim reports with multiple injurie... Read more
You Be the Coder:
Don't Get Paranoid Over a Paronychia Procedure with an E/M Code
Question: I have a question regarding whether to apply both the E/M code and the pr... Read more