ED Coding and Reimbursement Alert

 Most FAST exam claims also need modifier 26 Patients who report to the ED with abdominal trauma often require a FAST exam so the physician can check for internal injuries. The exam is a two-part procedure, and you must code both portions of the exam correctly to garner complete payment.

Who needs it? The FAST exam (focused abdominal sonography for trauma) is -typically used on abdominal and trunk trauma patients, particularly blunt-trauma patients, to find out whether internal bleeding is occurring,- says Joan Gilhooly, CPC, CHCC, president of Medical Business Resources in Chicago. The test -helps ED physicians figure out what they need to do for a patient -- and whether or not the patient needs to get to the OR quickly,- she says. Code First FAST Portion With 93308 The first part of any FAST exam is a limited transthoracic echocardiography (ECG). During this procedure, the ED physician checks for the -presence or absence of pericardial fluid,- says Pamela Cline, RHIT, coder at Medical Accounts Services in Frederick, Md.

You should represent this procedure on your claim with code 93308 (Echocardiography, transthoracic, real-time with image documentation [2D] with or without M-mode recording; follow-up or limited study).
 Part II of the FAST exam is a limited abdominal study, which the physician conducts to check for fluid in the abdomen. For this portion of the exam, you should report 76705 (Ultrasound, abdominal, real-time with image documentation; limited [e.g., single organ, quadrant, follow-up]). Attach Modifier 26 to Most FAST Exam Codes  When coding for a FAST exam in the ED setting, Gilhooly says, you will almost always need help from modifier 26 (Professional component).
 
-This shows the insurer that you are coding for professional interpretation of the exam. In the facility setting, there is a presumption that the facility is responsible for all facility charges,- Gilhooly says.

Don't forget to attach modifier 26 to both 93308 and 76705 to show that you are coding only for the professional portions of both codes, Gilhooly says.

Prove FAST Exam Necessity With These Dx Codes

On your claim, you-ll need to prove medical necessity for FAST exams with the proper ICD-9 codes, or you could face a rejection. According to Eli Berg, MD, FACEP, CEO of MRSI, an ED coding and billing company in Woburn, Mass., these ICD-9 codes will prove medical necessity for a FAST exam with most payers:

- 789.0x -- Abdominal pain

- 786.5x -- Chest pain

- 922.1 -- Contusion of chest wall

- 922.2 -- Contusion of abdominal wall

- 458.9 -- Hypotension, unspecified.  Best bet: Check with your payer for a list of ICD-9 codes that it will accept for FAST exams. -Many insurance companies -- especially Medicare carriers -- will not pay for FAST exam procedures if the diagnosis code is not on [...]