ED Coding and Reimbursement Alert

Diagnosis Coding:
Check Your Diagnosis Coding Skills With This Quick Quiz
From lacerations to ulcers, determine how you'd fare in these scenarios. On any given day... Read more
Modifiers:
12 Tips Help Sharpen Your Modifier Skills
Hint: Modifier 95 was responsible for scores of denials this year. Although every ED uses... Read more
Tonsillitis Coding:
Differentiate Acute, Chronic to Ace Tonsillitis Coding
Hint: Don't trust your EHR's default options. The colder temperatures have arrived, which... Read more
Reader Questions:
Get Specific With Nosebleed Control Codes
Question: A patient came to the ED with a nosebleed following an accidental head-butt by h... Read more
Reader Questions:
Pick the Correct PICC Line Code
Question: I'm looking for clarification about whether radiological supervision is required... Read more
Reader Questions:
Be Savvy About NPI Location
Question: I am a Medicare provider who recently moved from Minnesota to North Carolina and... Read more
Reader Questions:
Protect Those e-Signatures
Question: We recently performed a risk assessment in our ED and found that the e-sign... Read more
You Be the Coder:
Can You Code the Thorn in This Patient’s Side?
Question: A patient came into the ED with a thorn embedded in the subcutaneous tissue of h... Read more
E/M Coding:
Understand What “Additional Workup Planned” Means to This Payer
Getting to know UHC's definition can help you calculate MDM. According to CMS data, about... Read more
E/M Coding:
Check This Advice to Report Low-Level E/M Encounters
Sometimes you'll find that 99281 is warranted and appropriate. When patients present to ... Read more
ICD-10:
Get to the Bottom of Excludes1 Note Confusion With This Definitive Rule
New guidelines clarify previously murky area. Diagnosis coding can take years to master,... Read more
Reader Questions:
Sequence Your Modifiers Appropriately
Question: What are the rules governing multiple modifier sequencing? Massachusetts Subscr... Read more
Reader Questions:
Get the Scoop on Gout Coding
Question: We saw a patient with gout and we aren't sure how to report this condition, beca... Read more
Reader Questions:
Clarify When Modifier 59 Applies
Question: We used to report modifier 59 (Distinct procedural service) frequently, but our ... Read more
You Be the Coder:
Does Correlation Equate to Causation?
Question: I know all about avoiding the coding of diagnoses using probable, suspected, and... Read more
Reimbursement:
ED Providers Could Face Steep Cuts Under New Proposal
Plus: The government has proposed expanding telehealth into 2021. You'll find good news a... Read more
E/M Visits:
Improve Your E/M Documentation With Peer Audits
These reviews are quick, inexpensive, and effective. As you prepare for the calendar to t... Read more
Procedure Coding:
Consider 3-Step Approach When Coding Wound Repairs
First, be sure to know how to recognize what classifies as a laceration repair. When you... Read more
Reader Questions:
Know Complexity With Venipuncture Codes
Question: Aside from the age restrictions, what is the difference between venipuncture cod... Read more
Reader Questions:
Understand What Constitutes a Foreign Body
Question: An ED physician removed a piece of popcorn kernel from a patient's tonsils. What... Read more
Reader Questions:
No Incision? No Reporting 10120
Question: If the surgeon performs a foreign body removal (FBR) with forceps alone dur... Read more
Reader Questions:
Understand When to Report Signs, Symptoms
Question: We saw a patient for a cough, and the ED physician wanted the patient to get tes... Read more
You Be the Coder:
Can You Report E/M With Fracture Care?
Question: In last month's issue, you discussed the difference between fracture care and co... Read more
ICD-10 Coding:
New Diagnosis Codes Describe Substance Abuse, Withdrawal in Detail
Plus: You'll also find new codes for headaches. When patients arrive at the ED with sympt... Read more
Pediatric ED Visits:
3 FAQs Help You Report Pediatric Conditions in the ED
From ear infections to fractures, get the lowdown on reporting these conditions. Pediatri... Read more
Compliance:
Double-Check Your Telehealth Claims for These Essential Details
EDs may face audits in the very near future. Your ED has been working under the revised t... Read more
Don't Miss These Points in Your Telehealth Documentation
If you want airtight confidence that your telehealth and phone visits stack up against pro... Read more
Reader Questions:
Nail Down Strep Test Diagnosis
Question: We recently ran a rapid strep test on a young patient who came in complaini... Read more
Reader Questions:
Watch for Updated ABN
Question: We were told to use a new ABN form but we aren't sure if we have it or if we nee... Read more
Reader Questions:
Choose Carefully for Bladder Catheter Codes
Question: A patient with acute urinary retention (AUR) resulting in lower urinary tract ob... Read more
Reader Questions:
Remember External Cause Codes for Injuries
Question: A diabetic patient presented to the ED stating that she dropped a dirty kit... Read more
You Be the Coder:
Can You Code This Excision?
Question: Our ED physician treated a patient whose big toenail was almost completely torn ... Read more
Digestive Disorders:
Nail Down the Right Diagnoses for These Common GI Issues
 Hint: There may not be a huge difference between epigastric pain and heartburn. Gas... Read more
Billing:
Are You Overlooking These Areas Where Your ED Could Be Bringing in More Money?
From missing documentation to collecting patient balances, bring in more cash with these t... Read more
E/M Coding:
Sharpen Your E/M Coding Skills With 3 Quick Tips
Hint: Check your templates frequently. Your ED staff members are coding E/M services all ... Read more
Reader Questions:
Identify How to Code 'Unstable' Diabetes
Question: Our provider documented that a type 2 diabetic patient's condition was “unstab... Read more
Reader Questions:
Does HIPAA Apply to Contractor Outside US?
Question: Our company uses a small cloud services provider (CSP) based in Canada. Does HIP... Read more
Reader Questions:
Check Location for Cognitive Assessments
Question: What are the rules around reporting cognitive assessment code 99483? We are conf... Read more
You Be the Coder:
Keep Modifiers in Mind for Multiple Injuries
Question: A 20-year-old patient reported to the ED with right knee and thigh pain. During ... Read more
Facility Infusion Coding:
Quell Infusion Confusion With These Quick Tips
Time, primary codes are of high importance when coding these services. Every emergency de... Read more
Critical Care:
Count the Time When Reporting Critical Care
The 30-minute threshold is just one benchmark you must meet before billing these codes. A... Read more
ICD-10 Coding:
Use 3 FAQs to Nail Down the Right Diagnosis Codes
Check these strategies to select your ICD-10 codes. Diagnosis coding can be challenging, ... Read more
Reader Qeustions:
Avoid Hernia Code If the Condition Isn't Confirmed
Question: A patient came into our ED saying he thought he might have a hernia. Our pr... Read more
Reader Questions:
Consider Wound Depth When Billing Debridement Codes
Question: A 36-year-old male patient presented to the ED following a cycling accident... Read more
You Be the Coder:
Can You Sequence Orbital Fracture Codes?
Question: When coding multiple specified fractures on the same orbit, should we you u... Read more
Coronavirus Testing:
Look to 2 New Codes for COVID-19 Antibody Tests
These codes were approved by the AMA on April 10 and went into effect immediately. Emerge... Read more
Telehealth Coding:
3 FAQs Lead You to Telehealth Coding Success
Hint: Keep an eye on CMS' website to find out when adjusted rules subside. Most ED staffe... Read more
Accounts Receivable:
Boost Your ED's Income With These Solid A/R Tips
Once you know if you have an A/R problem, you can consider the solutions. The combinatio... Read more
Reader Question:
Consider How to Code Anaphylaxis Injection
Question: We saw a patient who came in after a yellow jacket sting. Initially she just had... Read more
Reader Question:
Not So Fast on Changing E/M Guidelines
Question: We heard that as of January 1, we will no longer need all three E/M components (... Read more
Reader Question:
Don't Differentiate ECG, EKG
Question: What is the difference between an ECG and an EKG? Codify Subscriber Answer: Th... Read more
Reader Question:
How Should You Code Heat, Ice?
Question: A patient came into the ED with an injured arm, and the provider gave him an ice... Read more
You Be the Coder:
Can You Differentiate Traumatic, Spontaneous Hip Dislocations?
Question: A patient recently arrived at the ED via ambulance with a right hip dislocation.... Read more
COVID-19 Coding:
Understand the Sequencing Nuances of New Coronavirus ICD-10 Code
Big changes will impact this diagnosis, for dates of service April 1 and beyond. As the c... Read more
Telemedicine Coding:
Get to Know These Facts About Reporting Telemedicine Codes in the ED
For the duration of the emergency, ED E/M codes are billable via telehealth. If you've ... Read more
Abuse Coding:
Consider These Diagnosis Codes When Seeing Suspected, Confirmed Child Abuse
Check these case studies for tips. Emergency department physicians are regularly faced w... Read more
Reader Question:
Nail Down 'Loose Body' Definition
Question: Our provider recently submitted a claim with a final diagnosis of loose body in ... Read more
Reader Question:
Know the Rules for Reporting Casting, Strapping Codes
Question: We often see patients with sprains or fractures and the ED physician uses castin... Read more
Reader Question:
Here's How to Differentiate HCPCS, CPT®
Question: When should we report HCPCS Level II codes versus CPT® codes? Are HCPCS Level I... Read more
You Be the Coder:
Differentiate Alcohol Depressive Disorder from Withdrawal
Question: What is the correct ICD-10 coding for a patient diagnosed with alcohol use disor... Read more
Observation Care:
Check These 3 FAQs to Improve Your Observation Care Coding
Hint: Sometimes watching the clock is essential. Many ED coders have questions about obse... Read more
ICD-10:
From Rhinitis to Ear Pain, See if You Can Pinpoint These Diagnosis Codes
Sometimes you may have to go beyond the initial issue to find the right code. Sure, you c... Read more
Part B Payment:
Use the Fee Schedule to Your Advantage With These Tips
The searchable database includes more information than you may have thought. Whether you... Read more
Reader Question:
Look to U0001 for Coronavirus Testing
Question: A patient presented to our ED with what seemed to be a cold, but she had recentl... Read more
Reader Question:
Don't Reach for Prolonged Service Codes
Question: We saw a patient in the ED with multiple problems, including diabetic neuropathy... Read more
Reader Question:
Go Beyond Surface Level for Foreign Body Removal
Question: We saw a patient who presented with a metal splinter in her hand. The ED physici... Read more
Reader Question:
Choose Burn Code Based on Size
Question: We saw a 6-year-old patient with a second-degree burn to the palm of her left ha... Read more
You Be the Coder:
Know How Thorough Student Documentation Must Be
Question: We currently have a few students working in our ED. In these cases, the chart no... Read more
Documentation:
Coders Identify 4 Common ED Coding Errors
Is your emergency department falling prey to these issues? When you evaluate your ED's co... Read more
Compliance:
Have You Built an Audit Plan? Payers Are Expecting It
Hint: Medicare isn't the only payer reviewing records for errors. No matter how diligent ... Read more
Compare Your Code Utilization Against These National Averages
If you're looking for a place to start when working to compare your ED's code utilization ... Read more
Reader Question:
Heed New Code for Vaping-Related Disorders
Question: We heard that a new code came out to describe when the ED physician addresses va... Read more
Reader Question:
Check 60000 Series for Lid Repairs
Question: We saw a patient with an eyelid laceration and the ED physician repaired it. We ... Read more
Reader Question:
Scrutinize Notes for UTI Diagnosis
Question: Our physician wrote “UTI” on a patient's chart. How can we find the right IC... Read more
Reader Question:
Compression Fractures Aren't Differentiated by ICD-10
Question: We saw a patient with a compression fracture of the foot bone. We haven't been a... Read more
You Be the Coder:
Check Notes for Osteomyelitis Dx
uestion: Our ED physician saw a patient who presented with right shoulder pain, and he dia... Read more
Part B Payment:
CMS: ED Visits Log 11.7 Percent Error Rate
National Part B overall error rate is only 8.6 percent, the agency notes. Emergency depar... Read more
E/M Coding:
Want to Confirm a High-Level ED Code? Examine the Note
Avoid upcoding your ED's services with these tips. As the government investigates high er... Read more
Billing:
Heed This Essential Advice When Family Members Walk Into the ED
CMS is not in favor of billing for services administered to family members. Chances are t... Read more
Reader Question:
Know Your Options for Bimalleolar Fracture
Question: We saw a patient with a bimalleolar ankle fracture. How should we code this? Co... Read more
Reader Question:
How to Proceed When Coder, Physician Disagree
Question: Our physician recently coded a critical care service using the time spent with t... Read more
Reader Question:
Know What Classifies As “Family History”
Question: Would you consider a physician documenting “No sick contacts” acceptable for... Read more
Reader Question:
Evaluation Options for Knee Dislocation
Question: When a patient suffers a dislocated patella, which ICD-10 code should I report t... Read more
You Be the Coder:
Who Can Perform Dental Work?
Question: Thank you for your article last month about dental visits in the ED. There is no... Read more
Toothache Coding:
Get the Scoop on Coding ED Toothache Visits
Patients with dental pain sometimes even arrive via ambulance. The symptoms can range fro... Read more
ICD-10 Quiz:
Test Yourself: Do You Know These New Diagnosis Codes?
From vomiting to pressure ulcers, new codes debuted in October for these conditions. Alth... Read more
Part B Coding:
Avoid Making Part B Errors With Tips Straight From the MACs
Avoid denials by implementing this simple action plan. Your ED likely has Medicare claim ... Read more
Reader Question:
Know what PHI Breaches Require
Question: If we think we may have breached a particular patient's protected health informa... Read more
Reader Question:
Avoid Modifiers on Unlisted Codes
Question: Our emergency department physician is performing multiple procedures during a tr... Read more
Reader Question:
Avoid Mix-Ups With Clavicle Fracture Repairs
Question: I'm having trouble keeping everything straight in the clavicular fracture repair... Read more
Reader Question:
Perform Some Sleuthing for Cardiac Arrest Dx
Question: If the ED physician documented that the patient has a diagnosis of cardiac arres... Read more
You Be the Coder:
Will You See Higher Pay for ED E/M Visits?
Question: A few months ago, you published an article noting that CMS was considering raisi... Read more
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