ED Coding and Reimbursement Alert
Even in the ED, PFSH Matters
PDF
.webp)
Question: Our doctors are great about documentation, except in one area. They rarely include any information in the past, family and social history (PFSH). This becomes a real problem when it's the only thing standing between a lower code and a higher one. What's the solution? Codify Subscriber Answer: The only solution to this situation is communication. You must explain to your physicians in your ED that the PFSH is one of the determinants of a history level, which can ultimately impact the level of E/M service that you report. It's very hard to calculate an accurate history level without knowing the PFSH. Many physicians say there isn't time to record this information in the ED, but in reality, these details can be the lynchpin to determining a patient's diagnosis, and since the doctor is asking about them, he must document them. When you meet with the physicians who aren't properly documenting the PFSH, bring along some sample documentation showing instances where an appropriately-completed PFSH might have increased the history level, and therefore the overall E/M level. Let them know the difference in reimbursement between the code you were forced to report and the one you could have reported so they understand the value of the PFSH in the future.
Related Articles
ED Coding and Reimbursement Alert
- Modifiers:
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 [...] - 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 auditors [...] - ICD-10:
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 substance [...] - You Be the Coder:
Check for the Right Tonsillitis Code
Question: Which diagnosis code should we report for acute tonsillitis? Codify Subscriber Answer: Fortunately, EDs that [...] - Reader Question:
Know When to Bill Two Insurers
Question: We saw a workers' compensation patient who presented with asthma due to inhaling wood dust [...] - Reader Question:
Observation Codes Are on RACs' Radar Screens
Question: Our physician was one of the doctors who saw a patient in observation care in [...] - Reader Question:
Adverse Effects May Prompt Additional Codes
Question: Our ED physician gave a theophylline prescription to a patient with asthma, but the next [...] - Reader Question:
Even in the ED, PFSH Matters
Question: Our doctors are great about documentation, except in one area. They rarely include any information [...] - Reader Question:
Cerumen Removal May Not Be Billable
Question: The ED physician saw an 18-year-old female patient with complaints of ear pressure and reduced [...] - Reader Question:
Know the X-Ray Coding Rules
Question: For an x-ray that included three shoulder views, our coder reported 73020-59 (one view) and [...]
