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Emergency Department Coding & Reimbursement Alert

2018 Coding:
4 Tips Prepare Your ED for 2018
Hint: Be aware of imaging, flu vaccine updates. As emergency departments nationwide prepa... Read more
The OIG's IT Audit Director Reveals Audit Details
Still using default passwords on software? Bad idea. You're familiar with Medicare audits... Read more
E/M Services:
Nail Down the Rules for Coding E/M Codes With Fractures
Coding E/M-fracture care? You'll need one of these E/M modifiers. When your ED physician ... Read more
Reader Question:
Know the Rules for Freestanding EDs
Question: The company that manages our ED has opened a freestanding emergency departm... Read more
Reader Question:
Know the Rules With Teaching Physicians, Residents
Question: Can our residents and teaching physicians report procedures that allow "sup... Read more
Reader Question:
Know Which Observation Codes Require History
Question: Do we need to document a family history before assigning code 99220 or 9923... Read more
Reader Question:
Don't Jump Straight to "T" Allergy Codes
Question: A patient came in to the ED with an allergic reaction, but we weren't able ... Read more
Reader Question:
Differentiate Anxiety, Depression
Question: Our ED physician treated a patient with insomnia and documented "anxiety de... Read more
You Be the Coder:
Avoid Prolonged Service Codes in the ED
Question: Can we report prolonged evaluation and management (E/M) services with emerg... Read more
CPT® 2018:
Prep Now for These 5 Big Coding Updates Effective Jan. 1
Hint: Be ready for big changes to chest x-ray coding. Just as you're prepping your coding... Read more
Lightning Round:
3 Frequently-Asked ED Questions Answered
This expert coder breaks down the answers to your most pressing ED questions. Coding for ... Read more
News You Can Use:
You Can No Longer Report ED Visits With Critical Care Codes
Even a modifier won't let you separate these edits. It's a common occurrence: The ED phys... Read more
Use These Tips to Create Synergy With Your Billing Firm
Billers, practices must work together to ensure smooth claims processes. Busy emergency d... Read more
Reader Question:
Know How to Code Undiagnosed "Pain"
Question: A patient presented to our ED with abdominal pain, but after a thorough exa... Read more
Reader Question:
Nail Down "Buddy Taping" Codes
Question: A patient came into the ED limping badly after falling off the jungle gym a... Read more
You Be the Coder:
Know How to Demonstrate Medical Necessity
Question: In your previous issue, there was an article about how the OIG downcoded a ... Read more
This Major Payer Now Requires Modifier SA on E/Ms Performed by NPPs
When your NP, PA, or CNS performs an E/M, you'll need to append modifier SA when billing U... Read more
Part B Errors:
This ED Error Is Among CMS's Examples of How Not to Report Claims
Check out the highlights from the government's latest error report to find out what audito... Read more
Your ED Will Have New Substance Abuse Dx Options on Oct.1
The upcoming edition of ICD-10 will offer several new options for patients who have substa... Read more
Reader Question:
Know When to Bill Two Insurers
Question: We saw a workers' compensation patient who presented with asthma due to inh... Read more
Reader Question:
Observation Codes Are on RACs' Radar Screens
Question: Our physician was one of the doctors who saw a patient in observation care ... Read more
Reader Question:
Adverse Effects May Prompt Additional Codes
Question: Our ED physician gave a theophylline prescription to a patient with asthma,... Read more
Reader Question:
Even in the ED, PFSH Matters
Question: Our doctors are great about documentation, except in one area. They rarely ... Read more
Reader Question:
Cerumen Removal May Not Be Billable
Question: The ED physician saw an 18-year-old female patient with complaints of ear p... Read more
Reader Question:
Know the X-Ray Coding Rules
Question: For an x-ray that included three shoulder views, our coder reported 73020-5... Read more
You Be the Coder:
Check for the Right Tonsillitis Code
Question: Which diagnosis code should we report for acute tonsillitis? Read more
Part B Fee Schedule:
2018 Medicare Fee Schedule Proposes Major Updates to ED Services
Could you end up with more money for your ED visits? CMS has released its 2018 proposed M... Read more
Behind the Numbers:
Find Out How the MPFS Proposal Could Impact Your Pay
Are fees going up or down? Potential changes to emergency department codes aren’t t... Read more
This Insurer Is Slashing Pay for Modifier 25 Claims
Be ready to see your income cut in half when you bill modifier 25 to this payer. You prob... Read more
3 Recent Cases Show ED Fraud Vulnerabilities
Make sure your compliance plan is ironclad to avoid these issues. Health care auditors ar... Read more
Reader Question:
Know When Tricare Pays First
Question: We had a patient present with Tricare and Medicaid. We know that Tricare is... Read more
Reader Question:
Follow This Quick NCCI Primer
Question: We have always added a modifier to separate National Correct Coding Initiat... Read more
Reader Question:
Look to L23-24 Series for Poison Ivy Coding
Question: We had a patient present with a rash for evaluation, and it turned out to b... Read more
Reader Question:
Consider 28190 for Foot FBR
Question: A 12-year-old male patient presented with complaints of a swollen foot. He ... Read more
You Be the Coder:
Know How to Code Multiple Infusion Days in Observation
Question: When we see observation patients, we aren’t sure how to report infusi... Read more
Breaking: You'll Find New Myocardial Infarction, Heart Failure Codes on Oct. 1
CMS has released the finalized list of 2018 diagnosis codes. If you've got high hopes tha... Read more
Observation Care:
Double Down on Your Observation Care Coding With Answers to 3 FAQs
Tackle these troublesome infusion and diagnosis questions. Coding for the observation car... Read more
Laceration Coding:
3 FAQs Direct You to the Right Laceration Repair Codes
Know when to add repair lengths together — and when you shouldn’t. Chances ar... Read more
Reader Question:
Use Reopening and Not Appeals Process for Clerical Errors
Question: We submitted a claim to our Medicare payer and then realized afterward that... Read more
Reader Question:
Use Secondary Dx for COPD, Bronchitis
Question: A patient presented to the ED who has chronic COPD and we diagnosed him wit... Read more
Reader Question:
Prep Now for New Medicare Cards
Question: A Medicare patient came to our ED and said she isn't allowed to show us her... Read more
Reader Question:
Hip Dislocation Coding Requires Treatment Specs
Question: Our physicians often see hip dislocations and it seems like they report a d... Read more
Reader Question:
Get Site-Specific for Achilles Tendon Injuries
Question: We saw a bicyclist with a ruptured Achilles tendon - which diagnosis code s... Read more
You Be the Coder:
Check the S13 Series for Neck Sprain
Question: Our physician treated a patient complaining of neck pain. Encounter notes i... Read more
E/M Coding:
Is UHC's New Policy Negatively Impacting ED Physicians?
"Additional workup planned" may not count in this coverage decision. Every emergency depa... Read more
New Proposed Codes Could Change Your Appendicitis Coding in October
Myocardial infarction, diverticular disease are also diagnosis codes to watch. Appendicit... Read more
Patient Privacy:
3 HIPAA Tips Every ED Must Know
Patient privacy still applies no matter how busy your ED is. Patients move in and out of ... Read more
Reader Question:
Know When Transports Are Billable
Question: What should we report when we’re treating a patient who is being tran... Read more
Reader Question:
Check Out This MAC's Modifier 25 Scrutiny Rules
Question: We frequently submit claims with modifier 25 (Significant, separately ident... Read more
Reader Question:
Assign Laterality When Known 
Question: In your last issue (Vol. 20, no. 6), you advised ICD-10 codes for a tick bi... Read more
Reader Question:
Be Ready to Answer EOB Questions
Question: One of our patients called the other day and asked us several questions abo... Read more
You Be the Coder:
Know How to Report CPR
Question: We had a patient go into cardiac arrest in our ED waiting room. The physici... Read more
Tackle This Summer Injury Coding Quiz
Can you code these common summer emergency room presentations? It’s probably been a... Read more
Emergency Department Errors:
ED Visit Claims Logged Over $260 Million in Errors Last Year
Here are the mistakes that were made - and how you can avoid them. Emergency department v... Read more
Radiology Coding:
3 X-Ray Tips Lead You to Coding Bliss
Collect every time for your ED radiographs with these quick tips. You're most likely repo... Read more
Reader Question:
State Refund Dates Differ
Question: Two years ago, we saw a patient who came to the ED for shortness of breath.... Read more
Reader Question:
Know What Critical Care Includes
Question: A 34-year-old patient with a tree nut allergy came to the ED after accident... Read more
Reader Question:
Differentiate Splinting From Strapping
Question: A patient came to our emergency department complaining of ankle pain after ... Read more
Reader Question:
Look for Broken Skin With Open Wound Dx
Question: We’ve noticed that one of our physicians reports the diagnosis code f... Read more
Reader Question:
Get Specific for Pinkeye Coding
Question: A patient presented to the ED with eye irritation and the physician diagnos... Read more
You Be the Coder:
Know the Rules for "External Cause" Diagnoses
Question: Can you share an example of when I might use the "External cause" codes in ... Read more
Critical Care:
Is That High Acuity ED Presentation Critical Care or Not?
Check for documented time and acuity of the presenting problem to inform your critical car... Read more
Use This Time Threshold Calculator
Make sure you have your time thresholds down with this chart from CPT®. Total Duration o... Read more
Getting It Right Can Help Your Practice Revenue
Consider the difference in payment for a level 5 ED E/M code 99285 (Emergency department v... Read more
Critical Care Scenarios:
Consider These Case Examples That Suggest Either Critical Care or Not
Certain documented phrases suggest the patient encounter qualifies for critical care. A c... Read more
Advance Beneficiary Notices:
New ABN Form Effective June 2017
Check out these rules for use as you prepare for the transition. The Centers for Medicare... Read more
Reader Question:
Be Aware of the Difference Between Includes and Requires In CPT® Language
Question: Is it required that an examination be documented in order to bill code 9921... Read more
Reader Question:
Can You Send Chart Back Asking for Missing Critical Care Time?
Question: I have a question about critical care documentation. What is the general co... Read more
You Be the Coder:
Who can Record the PFSH?
Question: Our ED record pulls information such as this from nursing documentation: P... Read more
Behavior Modification codes:
Use a Structured Screening Tool for Behavior Modification Services Coding
Make sure you know the rules before assigning codes for smoking or substance abuse counsel... Read more
Influenza Diagnoses:
Are You Up to Date on Your Influenza Diagnoses?
Avoid Denials by Coding Symptoms Supporting Medical Necessity of Flu Visits This has been... Read more
Reader Question:
You Have to Admit It, You Need an Admission Order to Report Codes 99218-99220
Question: We bill for emergency physicians who have just had added a Chest Pain Cente... Read more
Reader Question:
Take A Breath Before Billing For Nebulizer Treatments in the ED
Question: Our ED physician performs nebulizer treatments. What documentation gets thi... Read more
Reader Question:
Watch for the Requirement for Physician Skill Before Reporting Code US guided IV placement
Question: My doctors often do ultrasound guided peripheral IV access. For these patie... Read more
Reader Question:
Make Sure it is a Physician Service Before Reporting 90784
Report 90784 for ED Injections Question: When emergency physicians order antibiotics,... Read more
You Be the Coder:
Watch for Age and Provider in Assigning Your Moderate Sedation Codes
Question: Chief Complaint: Shoulder pain, Injury to left shoulder History of Present Illne... Read more
Put Your Best Foot Forward When Coding These Common Foot ED Presentations
Step up your coding on feet FBRs, sprains and application of casts and splints Feet get s... Read more
The Foot Bone's Connected to the Ankle Bone
Stepping up from the foot to the ankle is a great place to brush up on your coding for spl... Read more
Ventilator Management:
No Need to Vent. Use 94002, 94003 if Chart Documentation Doesn't Support an E/M Service
But your emergency physician will rarely provide just ventilator management. If your phys... Read more
Reader Question:
Look for the Link Before Counting Resident Documentation in Your Code Selection
Question: If no linking statement by the attending is present, which part of the resi... Read more
You Be the Coder:
Know Who Provided and Documented Each Service Before Assigning Codes
Question: How would you code this chart? We have some concerns about who provided/per... Read more
In-House Emergencies:
Make the Call: Subsequent Hospital, Outpatient Visit, or Consult?
Patient status and documentation will determine your code choice When an ED physician ... Read more
Observation Service Regulations:
Study the MOON to Stay Compliant with Observation Services
Know the rules and how they apply to ED care. CMS recently released more information o... Read more
Check Out The Actual MOON Form CMS 10611-MOON
Medicare Outpatient Observation Notice Patient name:           &... Read more
MACRA Pick Your Pace Options
How Will Emergency Groups Meet The Quality and PI Category Requirements? If you've been w... Read more
Reader Question:
Don't Hurt Yourself Over Coding For Suicidal Ideation in a Patient
Question: Can we report critical care for a patient with suicidal ideation and the re... Read more
Reader Question:
Don't Self Bundle Procedures Associated With Observation Services
Question: I've been told that patients placed in observation and then receiving prior... Read more
Reader Question:
Can A Moonlighting Resident Working in the ED Bill Independently?
Question: I have residents who moonlight for us in the emergency department. Do they ... Read more
You Be the Coder:
Not So Fast in Reporting that FAST Exam
Question: Chief Complaint Neck Pain following MVA HPI Vital signs per nurses notes ... Read more
MACRA Update:
CMS Eases The MACRA Required Timeline, Makes it Easier to Avoid a Penalty
15 potential ED measures listed in the DRAFT release, but you need only report 6 in 2017. ... Read more
MIPS Reporting:
MACRA Final Rule Lists Available Quality Measures for MIPS reporting
Choose from fifteen codes that have relevance to emergency medicine practice MIPS Eligib... Read more
Influenza Vaccine Update:
Look for Dosage Amounts Rather Than Patient Age for 2017 Flu Vaccines
Subtle changes in 2017 CPT® language can cause you to miscode if you don't have the lates... Read more
Nasal Hemorrhage Coding:
Sniff Out The Method or Technique When Coding For Controlling Nosebleeds
Check the chart carefully to see if a separate procedure is warranted for nose bleed prese... Read more
Reader Question:
Check What's Included in the Code To Sew Up Your Nail Bed Repairs
Question: We reported the following case with a nail bed repair and a laceration re... Read more
You Be the Coder:
How Do You Code for a Patient Presentation When It Appears Nothing is Wrong?
Question: Although this chart is well documented, it appears there is nothing wrong... Read more