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  1. M

    coding from x-ray report in ED

    Yes, since the provider who was responsible for direct care of the patient diagnosed the fracture, the radiology report can be used for more specificity. http://www.hcpro.com/HIM-323519-5707/QA-Emergency-room-documentation-and-radiology-reports.html
  2. M

    Help with Dx code

    I would code it as a toxic effect plus any manifestations of the poisoning.
  3. M

    ER injections

    In lieu of a specific facility guideline, we end all ED facility services when the provider writes the order for inpatient or observation services. Most of my recent facilities want all injections and infusions billed until the patient leaves the ED. Your facility should have a policy regarding...
  4. M

    concurrent infusion coding

    A concurrent infusion is a new drug/substance infused at the same time as another drug/substance. It is not time based and does not need to be infused at the exact same time as the other therapeutic infusion. Your second infusion would be a concurrent infusion if the same site was used for both...
  5. M

    Medical coding outsourcing overseas

    Yeah right, Raja. Many of us prefer to keep our jobs and our protected health information in the US. SymMetric Revenue Solutions formerly known as Apollo Information Systems, Inc. in Fort Myers, FL terminated 38 coders two months ago because they chose to outsource to India. My feedback...
  6. M

    Axilla abscess/Sebaceous cyst removal??

    I agree with 10061.
  7. M

    Critical Care ?

    ACEP has info on billing ED facility critical care: http://www.acep.org/Content.aspx?id=30428 I look for the criticality of the patient (unstable VS, organ impairment/failure), an intervention and at least 30 minutes of care rendered by the nursing/ancillary staff (after subtracting any billed...
  8. M

    FAST charge on ER bill

    From the ACEP website: FAQ 1. What is the appropriate code for the FAST (Focused Assessment with Sonography in Trauma)exam? There is no specific CPT-defined code for the usual clinical FAST exam. Rather, the exam is reportable as two distinct limited ultrasound examinations, when the...
  9. M

    Ultrasound Guidance in ED

    Look at 93970/93971 for the DVT and to examine the inferior vena cava - 93979.
  10. M

    ARNP Triage in the ED

    E/M services provided in the ED use 99281-99285. Both the hospitalist and the EDP can use these codes on the same date. Outpatient E/M services on the same DOS that result in a hospital admission are included in the Hospital Care codes. For a non-Medicare consult in the ED, use the...
  11. M

    CPT for placement of femoral quinton dialysis catheter

    36555 for patients younger than 5 years 36556 for age 5 and older
  12. M

    help with procedure-Can I please get

    This would not be coded as a central venous access procedure since the documentation does not support the catheter tip terminating in the subclavian or innominate vein. Usually, the internal jugular, subclavian and femoral veins are used for central line access in the ED. Look at the...
  13. M

    Bivalving Short Arm Cast

    I agree with 29700. Gauntlet (covering the hand and fingers like a glove) describes the short arm cast.
  14. M

    Intrabursal Injections??

    Are you looking for the actual administration CPT (20600, 20605, 20610) or a medication?
  15. M

    # of Diagnosis or Treatment Options in the ER

    We cap it at 3 points. If we did not limit it to one problem, a kiddo with a febrile seizure discharged with a antibiotic for AOM would be a level 5. I noticed that Novitas and E/M University allow a maximum of 1 new problem to the examiner in their MDM calculator/worksheet.
  16. M

    CPR 92950 x?? Per Day

    The MUE for 92950 per date of service is 3. I would only bill once per encounter. If the patient coded in the ED and required CPR and then transferred to ICU where the EDP made a floor call for the same patient requiring CPR, I'd bill the 92950 again with supporting documentation and the correct...
  17. M

    Dental Filling

    We use 41899 in the ED for dental procedures.
  18. M

    MDM/Risk Table in an ED setting

    It is beneficial to have a committee that addresses this type of scenario for consistency. The MDM can differ depending on the facility or billing company. I have seen a low risk assigned for a bump on the head that requires no work up, Rx or repair beyond steri-strips with no LOC, mental status...
  19. M

    cpt code - I have doubt

    Since no imaging or additional anatomical landmarks were documented, I'd be looking at 20552.
  20. M

    ED Hydration

    http://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/downloads/R2141CP.pdf
  21. M

    caveat -find it documented

    From the ACEP website: The Level 5 Caveat The definition of 99285 includes the concept that the History, Physical Exam, and Medical Decision Making requirements must be met "within the constraints imposed by the urgency of the patient's clinical condition and/or mental status". Most Medicare...
  22. M

    Professional ER Coding

    Gosh, I hope the level twofers don't code themselves out of a job D/T lower reimbursements. Yeah, I like to stir the pot...
  23. M

    Police Taser barbs removal, Police dog bites

    I concur - no incision, no CPT for barb removal. As for the dx codes, I'd use the open wound, complicated, since the barbs do not appear to be superficial and they are foreign bodies. 924.10 is a contusion code, 982.5 is invalid. E974 seems to fit the injury E Code.
  24. M

    follow ups

    For a single abscess, placing a drain or packing is required for 10061. A culture can be obtained by manually expressing the abscess - often without an incision.
  25. M

    ED coding question

    This sounds like a test question. An antibiotic administered SQ seems odd but whether SQ or IM, the code is the same - 96372. Modifier -59 should be appended to a subq/IM injection with a wound repair code. 90471 is the tetanus administration code.
  26. M

    Professional ER Coding

    I agree. This is a low moderate on the table of risk for a minor trauma requiring a diagnostic resulting in a 99283 with supporting documentation of at least an EPF history and exam. The compliance/coding gurus note that an uncomplicated injury does not require any diagnostic work up/ancillary...
  27. M

    An ED case that I'm struggling with

    I have been fortunate to work with companies that have talented groups of professionals who make up their compliance committees. They have strict coding guidelines they are constantly tweaking for consistent coding. Each entity should have these protocols in place for their coders. Splitting...
  28. M

    follow ups

    We wouldn't bill another I&D within the 10 day global of the same site.
  29. M

    need help with procedure-Placement of aluminum stent

    Was anything else documented such as the use of a rongeur, flap creation or nail bed removal/repair? Perhaps, a nail bed repair 11760 with modifier -22 appended if documentation supports the extra service. Keep us posted on what you decide.
  30. M

    E code help.

    E920.8 I've used the vague activity code E002.9 for fishing.
  31. M

    An ED case that I'm struggling with

    99283 Deciding between 99283 or 99284 in the ED can make one's head spin. We split the moderate MDM risk into low moderate (99283) and high moderate (99284) with guidelines for each level for consistent coding.
  32. M

    Does this qualify as foreign body removal?

    It looks like an intermediate repair requiring removal of particulate matter with single layer closure. There wasn't any gross contamination with significant devitalized tissue removed to warrant a separate debridement code. I'd also assign a complicated wound diagnosis code due to the grit...
  33. M

    Rabies vac

    For the Rabies Immune Globulin (RIG) administration, we assign 96372. We use 90471 for the rabies vaccine administration.
  34. M

    Kicked a dog

    If the documentation doesn't state accidental or self-inflicted, how about E988.8?
  35. M

    nasogastric tube

    I would assign 996.79 for the complication of the NGT, 707.9 and E879.x.
  36. M

    Ortho procedure in Emergency Room

    The only strapping code I use is 29240, shoulder strapping, for sling and swathe or figure eight applications.
  37. M

    infusions again please

    96365 and 96367 x2. 96366 is assigned for each additional hour (minimum of 31 minutes beyond the initial 60 minutes) of an infusion of the same drug. For example, if Vanco infused from 0200 to 0331, assign 96365 and 96366. Clear as mud. :)
  38. M

    Pharyngitis Level in the ER

    We would assign 99283 for this type of visit: new problem, no additional workup, no data reviewed with a low moderate risk. If the Rx has a greater risk (narcotic), we assign a high moderate risk for a level 4.
  39. M

    FAST help?

    FAST Exam Check out the US FAQs on the ACEP website: http://www.acep.org/content.aspx?id=30502 "There is no specific CPT-defined code for the usual clinical FAST exam. Rather, the exam is reportable as two distinct limited ultrasound examinations, when the requirements of both are performed: •...
  40. M

    Ng tube placement

    I found a couple of resources that state: Code 43752 is not applicable to the placement of a tube without radiologic guidance. The revision to specify fluoroscopic guidance enables better delineation for reporting purposes. This revision came about because non-physician clinical staff commonly...
  41. M

    concurrent infusion

    96365, 96366, 96368 if infused via the same site.
  42. M

    therapeutic infusion with push.

    The Rocephin infusion is the initial service, 96365, and the Zofran is an IVP of a different drug, 96375. This may be a homework question because of the fluid volume of the Rocephin (1 gm is usually given in 50-100 ml of solution). If not, I would remove the nurse's name in your post if it...
  43. M

    Kcl administration code

    Potassium replacement aka a K-rider is a therapeutic infusion. Many facilities add 10mEq KCL in 100 ml NS and infuse over an hour.
  44. M

    Wiki abdominal pain and pregnancy in ED

    As others have suggested, read the chapter 11 guidelines. The guidelines note it is the provider's responsibility to state that the condition being treated is not affecting the pregnancy to assign V22.2 in place of chapter 11 codes.
  45. M

    dislodge cathter

    A displacement is a mechanical complication - look at 996.1 since the permacath is a vascular catheter placed for hemodialysis. If the encounter involved the replacement also use V56.1 and any associated condition. 996.7x is used for complications involving a clot, bleed, stenosis, pain... A...
  46. M

    Infusion vs IV push

    The last documentation that the substance was infusing (reassessment of the infusion or titration of drips in the nurse's notes) may also be used as the stop time. Time-based codes require documentation of time. We keep track of deficient infusion documentation so the ED Nurse Manager can use it...
  47. M

    Attempted spinal tap

    http://www.supercoder.com/coding-newsletters/my-pediatric-coding-alert/modifier-is-key-to-optimal-lumbar-puncture-coding-article A completed procedure can be billed whether or not it was successful. Modifier -52 isn't needed unless the EDP partially eliminated or reduced the procedure. Multiple...
  48. M

    infusion/hydration

    If these infusions were administered via one site, I would code as 96365, 96367, 96368, 96361 since the Levaquin requires 91 minutes for the additional hour of 96366 to be assigned (per CPT report 96366 for infusion intervals of greater than 30 minutes beyond 1 hour increments). Hydration...
  49. M

    concious sedation

    The general rules regarding time-based codes apply; you need more than 50% of the time requirement (a minimum of 16 minutes) to code CS (99143, 99144, 99148 and 99149). The time starts with the administration of the sedation agent(s) and ends at the conclusion of personal contact by the...
  50. M

    Ramipril poisoning

    Lance, I use Antihypertensive agents NEC 972.6.
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