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Emergency Department Coding & Reimbursement Alert

Trauma Coding:
Use These 3 FAQs to Guide Your Trauma Claims
From gunshot wounds to fractures, find out how to code these traumas. Some EDs are known ... Read more
Medicare 101:
MAC Rep Dispels 8 Myths About Medicare
New to Medicare coding and billing? These tips will help you get to know the system. Are ... Read more
Patient Data:
Medical Center Staff Under Fire for Exposing Patient Data
Even if your technology isn't compatible between departments, you must still follow the HI... Read more
Reader Question:
Follow These Tips for Audit Success
Question: We had an outside consultant come in and review our ED claims. He pointed out se... Read more
Reader Question:
Nail Down Medicare Secondary Payer
Question: Who is the Medicare Secondary Payer? Is that Tricare? Supercoder Subscriber An... Read more
Reader Question:
Evaluate Code Options for Multiple Fractures
Question: When a patient reports with multiple fractures, how does the coder decide which ... Read more
You Be the Coder:
Pin Down Vent Management Documentation
Question: What documentation is necessary when reporting vent management? Supercoder Subs... Read more
CPT® 2020:
Check out These New CPT® Codes for Spinal Puncture
You'll find 394 total code changes effective Jan. 1. Coding spinal punctures performed in... Read more
ED Visits:
Part B MACs, Private Payers Launch Probes of ED E/M Codes
You'll need to stay on guard. Billing ED visits may seem simple at first glance, but rece... Read more
News You Can Use:
UHC: $32B Wasted in Treating Conditions in ED That Could Be Seen in Primary Care Offices
10 specific diagnoses drove the overuse of ED services. Your ED is likely to see patients... Read more
Verify the Diagnosis Codes When Treating Contusions
Laterality, location count when seeking these ICD-10 codes. Selecting the most accurate c... Read more
Reader Question:
Get A Handle on ePHI
Question: Our ED recently switched to receiving faxes electronically. What is the best way... Read more
Reader Question:
Note Mention of I&D When Treating Paronychia
Question: We billed the following service with 26010, but an auditor said it should have b... Read more
Reader Question:
Evaluate Options When Provider Performs Fx Care, Splinting
Question: We saw a patient who presented complaining of a right wrist injury, but we ... Read more
You Be the Coder:
Get Closure on This Closure Question
Question: A 28-year-old male presented to a freestanding ED at midnight after being struck... Read more
Part B Payment:
Find out How the Proposed 2020 Fee Schedule Could Affect Emergency Departments
If the proposal is finalized, you could collect more for E/M services in the ED. Some yea... Read more
Check Out These Additional Proposals That May Affect EDs
This year's changes could go beyond E/M services. In addition to the proposed changes to ... Read more
3 FAQs Help Solve Your ED’s Debridement Questions
Hint: For some debridements, you'll need to measure the wound. When patients present to t... Read more
Change in TC, PC Billing Policy Could Impact Your ED
Get the scoop on how Medicare views technical, professional components now. The way the c... Read more
Reader Question:
Get the Scoop on 99408
Question: We saw a patient for a panic attack who revealed a cocaine addiction. The ED phy... Read more
Reader Question:
Get Specific When It Comes to Pain Dx
Question: We saw a patient in the ED with right upper abdominal pain but after testing, th... Read more
You Be the Coder:
Look to “S” Series of ICD-10 for Disc Rupture
Question: Notes indicate that the ED physician saw a patient recovering from a traumatic r... Read more
Are Your 99285 Claims Above the Average?
Check the outcomes from this comparative billing report for the scoop. Are most of your c... Read more
E/M Coding:
Nail Down the ROS Basics with These Tips
Ready to report E/M codes in the ED? Heed these ROS best practices. When tallying the his... Read more
Where Does Your State Stand?
In addition to its overview of the results, RELI Group released a spreadsheet showing stat... Read more
Pulmonary Hypertension Cases Require Sleuthing to Find the Right Code
Turn to I27.22 for left heart disease. Selecting the right code to describe a patient's p... Read more
Reader Question:
Are Admits Being Tracked?
Question: We recently had a meeting with hospital administrators where they said we're adm... Read more
Reader Question:
Here’s How to Monitor Collection Agencies
Question: We've had some issues with our collections firm in terms of accuracy and transpa... Read more
Reader Question:
Get the Scoop on X{EPSU} modifiers
Question: Which payers accept the X{EPSU} modifiers? We've had very little success with th... Read more
Reader Question:
Pinpoint the Dx Code for Perianal Strep
Question: We recently saw a toddler in the ED who presented with a severe case of diaper r... Read more
You Be the Coder:
Manage Multiple Diagnoses
Question: We saw a patient who ended up having more than 12 diagnoses. Is there a way to r... Read more
Diagnosis Coding:
Look for New Pulmonary Embolism, Poisoning Codes on Oct. 1
The 2020 diagnosis code list includes nearly 400 changes. From heart conditions to bone i... Read more
E/M Coding:
Return to Sender? How to Know When to Ask Providers for Addenda
Determine when – and how – you should ask the physician to expand documentation. When... Read more
Patient Privacy:
Patient Coordinator Could Face Jail Time Due to Wrongful Disclosure
Separate locations must also stay in tune with HIPAA rules. Are your staffers potentially... Read more
Reader Question:
Turn to the I46 Series for Cardiac Arrest
Question: We saw a patient with a diagnosis of cardiac arrest. What ICD-10 codes should we... Read more
Reader Question:
Differentiate Cluster Headache From Migraine
Question: During a level-three E/M service in the ED, the physician diagnosed a patie... Read more
Reader Question:
Evaluate Dislocation Options
Question: A patient reported to the ED complaining of severe elbow pain. After a deta... Read more
Reader Question:
Know the Hydration Rules
Question: A 92-year-old nursing home patient arrived at the ED via ambulance showing ... Read more
Reader Question:
Avoid Unlisted With Gunshot Wound Exploration
Question: We are trying to code a chest exploration following a gunshot wound. Should... Read more
Reader Question:
Get the Scoop on Dental Pain Visit
Question: A patient reported to the ED at 8 a.m. on a Sunday morning. He described a ... Read more
You Be the Coder:
Know When the Critical Care Clock Starts Running
Question: Thank you for your article last month on critical care coding. One question we h... Read more
Critical Care:
Nail Down the Answers to These Pressing Critical Care FAQs
Hint: Discharged patients may still require 99291 or +99292. Critical care coding happens... Read more
Wound Care Coding:
Master Laceration Repair Coding With 8 Key Tips
Size, location, and severity are all important factors. Not a day passes without an ED ph... Read more
Can You Decipher These Common Infection Diagnoses?
Some are straightforward, others require several steps. From strep throat to otitis media... Read more
Reader Question:
How Do You Support Caveat Intent?
Question: How does CMS audit records when the acuity caveat is used to explain the ED phys... Read more
Reader Question:
Report Can Reveal Cyst Details
Question: A patient with a growth on the side of his face presented in the ED. The physici... Read more
Reader Question:
See Documentation for Foley Change Stats
Question: In our ED, we use a supply charge for Foley catheters if they are placed in the ... Read more
Reader Question:
Jones Dressing Isn’t A Splint
Question: Should I consider a Jones dressing a splint or a strap for coding purposes? It d... Read more
Reader Question:
Separate Observation From E/M
Question: I've heard that ED physicians cannot charge for both an ED E/M and observation s... Read more
You Be the Coder:
Check CCI When Coding E/M, Injection
Question: Thank you for your article last month about spring allergy coding. We have a fol... Read more
Seasonal Coding:
Don’t Sneeze at Coding Spring Allergy Reactions
Check out this anaphylaxis scenario and determine whether you can code it. When patients ... Read more
Fracture Coding:
Can You Answer These Fracture FAQs?
See how strong your fracture coding skills might be. Sometimes it seems like not a day go... Read more
ED Mythbuster:
Pinpoint the Reality of These ECG Myths
Find out the scoop about appending modifier TC to ECG claims. Your ED is likely to perfor... Read more
Reader Question:
Get the Scoop on Student Documentation
Question: We have a student currently at our clinic. Is this correct on documentation rule... Read more
Reader Question:
Write on This Writeoff Plan
Question: We have had a few patients who don't pay their bills, even if we offer discounts... Read more
Reader Question:
Determine How to Code Split Service
Question: A doctor in our emergency department removed staples that a different doctor had... Read more
Reader Question:
Find out How to Report Respiratory Distress
Question: Our ED physician documented a patient in “respiratory distress.” Which code ... Read more
Reader Question:
Does This Constitute Critical Care?
Question: A patient became unresponsive in the ED and the physician began critical care bu... Read more
Reader Question:
Here’s How to Report Urgent Care Services
Question: We recently opened an urgent care clinic separate from the ED. Which E/M codes s... Read more
You Be the Coder:
Confirm A Typical Flutter Vs. Atypical Flutter
Question: The physician documented a typical atrial flutter. Which ICD-10 code should we r... Read more
3 Recent Cases Reveal ED Fraud Vulnerabilities
Scrutinize your compliance program to avoid such issues. As healthcare auditors increasin... Read more
Can You Answer These Diagnosis Coding FAQs?
Hint: Heed sequencing when necessary. ED providers see such a wide variety of diagnoses t... Read more
FBR Coding:
Subcutaneous Foreign Body Removals? Check for Incision
 Don't sacrifice pay for these common problems. Emergency department providers don't... Read more
Reader Question:
CMS: New MBI Numbers Should Now Be the Norm
Question: How long do we have before we need to start reporting Medicare claims with the p... Read more
Reader Question:
Understand the Toe Laceration Codes
Question: We saw a patient who presented with lacerations of the great toe without nail da... Read more
Reader Question:
Can You Separately Report Heat, Ice Treatment?
Question: A patient came into the ED with an injured arm, and the provider gave him an ice... Read more
Reader Question:
Nail Down Limb Pain Dx
Question: A patient reported to the ED complaining of pain in his entire left leg; he said... Read more
Reader Question:
Pinpoint Rules for Double ED Visits
Question: We saw a patient in the morning for a bloody nose and then he came back in the a... Read more
Reader Question:
Get to Know Nose, Throat Anatomy
Question: Our ED physician's procedure notes indicates that he inserted a scope through th... Read more
Reader Question:
Which Diagnosis Applies in Observation Care?
Question: Our understanding is that the first-listed diagnosis must be used in lieu of the... Read more
You Be the Coder:
Find out Whether Moderate Sedation is Billable in ED
Question: In the emergency room setting, can the ED provider perform an intubation and als... Read more
ED News:
CMS Unveils New Payment Model for Emergent Patients
Under the five-year model, ambulances can take emergency patients directly to their doctor... Read more
E/M Coding:
Get A Handle on the MDM Level of Risk Data Points
Can you count the points on the medical decision-making aspect of your documentation? Ima... Read more
Four tips to perfect your E/M choices
If indecision about medical decision-making is throwing your E/M reporting for a loop, con... Read more
ICD-10 Coding:
Sequencing Rules Essential for Sepsis Coding
When it comes to the regulations for coding this condition, take note of a few key facts. ... Read more
3 Tips Lead to Perfect Self-Audits
No audit plan? Then Your ED could be at risk. Medicare auditors are stepping up their rev... Read more
Reader Question:
Vent Management Vs. Critical Care
Question:  Our physician performed vent management on a critically ill patient. We re... Read more
You Be the Coder:
Differentiate Cardioversion, Defibrillation
Question: Our ED physician used cardioversion/defibrillation on a patient in cardiac ... Read more
Observation Care:
CMS Finds Observation Care Claims Often Lack Appropriate Documentation
Incorrect coding errors also plague these services. It's a common occurrence at your ED ... Read more
NCCI Edits:
CMS Offers Update to Spell Out When Modifier 59 Applies to NCCI Edits
If you've ever been confused about when to separate bundles, here are the facts. You've c... Read more
ED Coding 101:
Have You Mastered E/M Coding for the ED?
Hint: No need to stress about the ‘three-year rule.'  It's common for coders who a... Read more
Reader Question:
Is Time on Your Side With CPR Billing?
Question: What are the time requirements associated with CPR code 92950? Answer: Code 929... Read more
Reader Question:
What Happens to HIPAA When Information Spans Borders?
Question: Our practice uses a small cloud services provider (CSP) based in Canada to store... Read more
Reader Question:
Find out How to Handle New Physician’s Billing Info
Question:  A new physician started at our emergency department practice, but he hasn'... Read more
Reader Question:
When Are Signs/Symptoms Reported?
Question: We have one physician who reports every sign and symptom that the patient presen... Read more
Reader Question:
Evaluate Nail Avulsion Codes
Question: A patient presented with a big toenail that was torn almost completely away from... Read more
Reader Question:
Does Q6 Apply to Nurse Practitioner?
Question: Are we allowed to report a nurse practitioner's (NP) services to Medicare with a... Read more
You Be the Coder:
EDs Brace for Payer Changes
Question: Our ED heard at a conference last weekend that our Blue Cross Blue Shield payer ... Read more
Part B Payments:
CMS: 11.3 Percent of ED Visits Were Paid Improperly
Emergency department practitioners exceed the national improper payment rate. Your emerge... Read more
Know The Coding Errors That CMS Evaluated
CMS identified $31.6 billion in total improper payments among providers during 2018, and b... Read more
RACs Boost Scrutiny of Modifier 57
From fractures to other services, you probably use this modifier now and then – find out... Read more
Get A Handle on Global Periods When Considering Modifier 57
The CMS Global Surgery Booklet is a great starting point to investigate the nuan... Read more
Reader Question:
Know the Rules When Communication Problems Exist
Question: A patient who is unable to communicate clearly and to explain her medical proble... Read more
Reader Question:
Find out Whether Modifiers Have Associated Prices
Question: Using the Resource-Based Relative Value Scale (RBRVS), what are the relative val... Read more
Reader Question:
Get the Scoop on This ICD-10 Puzzle
Question: A computed tomography (CT) scan is performed on a patient with a chronic middle ... Read more
Reader Question:
Documentation Reigns With Burns
Question: A patient presented to the ED with a burn to his left eyelid after a spark from ... Read more
Reader Question:
Oxygen Isn’t Separately Billable
Question: When a patient requires oxygen, which CPT® codes should I use for administering... Read more
You Be the Coder:
Should You Always Code Smoking Status?
Question: At the beginning of the J section in the ICD10-CM manual, there is a note to cod... Read more
2019 Payment:
CMS Chooses Not to Implement E/M Changes in 2019
But some new updates are applicable to EDs. Emergency departments have been keeping a clo... Read more
Catheter Placement:
Evaluate Your Catheter Placement Code Options
Step one: Identify “indwelling.” If you're reporting 51701 (Insertion of non-indwelli... Read more
Straighten out Your Appeals Processes in the New Year
Avoid blindly appealing — first, do your research. With the turn of the calendar often ... Read more
Reader Question:
Get to the Bottom of Excludes1 Note
Question: If an Excludes1 note is listed after an ICD-10 code, does that mean you can neve... Read more
Reader Question:
Will Medicare Pay for Non-Covered Workers' Comp Visits?
Question: Thank you for your Q&A last month about workers' compensation coding. I have... Read more
Reader Question:
Know the Region for Radiculopathy
Question: A patient presented to our ED with back pain, and the physician diagnosed her wi... Read more
Reader Question:
Check 90689 for Flu Vaccines
Question: Our office manager heard that a new flu vaccine code will be coming out for 2019... Read more
You Be the Coder:
Get A Handle on Modifiers
Question: Our ED physician attempted to reduce a fracture of the left hip, but was unable ... Read more