Wiki Emergency Department Infusion and Injection - I am looking for information

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Coding2

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Hello,

I am looking for information reporting ER injection and infusion reporting on claim. There is a discprency between HIM and the billing department. I am reporting injection codes 96374, 96360 etc on claim but the billing department is stating these codes when put in the grouper are overriding the E/M code and we should not put them on the claim. These infusion and injection codes are not built in the charge master and that is why we are soft-coding them on the record and into the grouper to be reimbursed for services.

I was looking for any help regarding this matter. From what I can tell both need to be present. Because the inj/infu are timed services they need to be present as well as the E/M code. Is this correct.

Thank you
 
Yes you are correct, the E&M code needs a 25 modifier for facility billing just as in physician billing. It could be that the chargemaster does not have the 25 modifier built in or it has two charge codes for each E&M one with the 25 modifier and one without. You should check with the chargemaster department.
 
ER infusion and injection and E/M

Thank you so much for your reply. Just so I am clear, I can code the 99.29/96374, etc on the record and enter in the grouper for facility billing. The E/M would have a modifier 25 attached as an inj/inf was done. If this E/M code is overriding the CPT code there may be a glitch where it is pulling from and needs to be changed where to pull the E/M from. This is regardless of what type of insurance?

Also, the billing department was leaving all the inj/inf off the claim due to the E&M code was not pulling so we have lost reimbursement for these ER services done by nursing.

Again thank you I just wanted to clarify further as we are meeting with the CDM department.
 
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do not use the 99.29 code for an ER claim, that will cause your claim to deny. The Vol 3 codes are inpatient only use, and the 96372/4 are outpatient only. Yes it should not be overriding the E&M code. you will need the 25 modifier on the ER E&M, and it does look like you have lost significant revenue.
Look at your E&M tool carefully and be sure that the activity of administering injections and IVs is not a part of your E&M assessment tool. That is extremely important. Your facility tool should show the utilization of resources that are not reported by any other code, such as taking vitals. Be sure you are not using the physician guidelines for your facility E&M level.
 
ER infusion and injection and E/M

Thank you so much for your reply. Just so I am clear, I can code the 99.29/96374, etc on the record and enter in the grouper for facility billing. The E/M would have a modifier 25 attached as an inj/inf was done. If this E/M code is overriding the CPT code there may be a glitch where it is pulling from and needs to be changed where to pull the E/M from. This is regardless of what type of insurance?

Also, the billing department was leaving all the inj/inf off the claim due to the E&M code was not pulling so we have lost reimbursement for these ER services done by nursing.

Again thank you I just wanted to clarify further as we are meeting with the CDM department.
 
Coding ERs

Thank you for your feedback, learning. To report the CPT code in our grouper there is a procedure line ICD 9 along with the CPT. We were instructed to enter the ICD proc code along with the CPT for strictly outpatient (er/ambulatory/surgery) as I do not code inpatient, inj/infus, sutures 86.3, reductions, etc.

On your claims do you put the CPT code for outpatient, inj/inf, sutures, etc by itself in a screen with no ICD-9 proc code? We have the grouper that on each line asks for the ICD 9 procedure code and CPT and date. Maybe we just have to bypass the ICD procedure code and enter the other information.

Any information regarding the E&M assessment tool would be greatly appreciated. Another department assigns the E&Ms, but only modifier 25 is added if there was a reduction, sutures, cast, FB removal, etc. I will have to pass on the info if any inj/inf done in the ER the E&M also needs the 25 mod.

Again, thank you, any information is greatly appreciated.

Coding2
 
Yes most facility systems come with either a DRG grouper or an APC grouper. If you are set tothe DRG grouper then the Vol 3 codes will be required, but someone then must remove them before the claim can drop or it will be denied. In the facilty I work in the IT dept made it possible to select which type of claim we wore working .. ie DRG or APC, for outpatient you want APC, then the system does not require the Vol 3 codes, this then requires less duplication of work as no one then ha to re review the claim to remove the vol 3 codes.
The facility E&M assessment is based on criteria developed by each individual facility for assignment of the facility E&M. We call it the facility assessment tool, ours is based on points. and the number of points equals a visit level. You do not use the physician guidelines for the facility level and the levels do not have to match, the physician might assign a level 1 the facility might assign a level 2 or even 3, as lonf as your documentation can support it.
 
Coding confusion

Thank you for your wealth of information, it has been very useful and I have a better understanding. My system is set to the DRG grouper. I had been instructed to use this screen to enter so did not question the 4 digit ICD 9 procedure codes. I will check into setting it to the APC grouper and use this for all OP claims (ER, ancillary, ambulatory).

Just to summarize, I am going to enter all outpatient codes in the APC screen. I can put inj/inf codes on the claim if not already built in or captured elsewhere. If any inj/infusions or other procedures are done in the ER a modifier 25 needs to be added to the E&M claim facility billing. I will not use 4 digit IC9 proc codes on any outpatient claims.

I appreciate all your information.

Coding 2
 
inf codes

Follow your hierarchy of ivp and infusions the 96360 has to be 96361 in correlation of 96374 cannot have a hydration initial with a IV push or Infusion initial.
 
Utilization review

I code on a acuity level sheet for the ER I am needing more information on coding stat heart pt or infusions that run in two initial site along with concurrent site is there a web site that I could use for example to practice and test myself for accuracy. my trainer is not a very knowledgeable person and when I ask her questions she states "I don't know how to explain it" for example medical necessity of two site one in the left wrist and one in the left forearm magnesium infusion and one azithromycin infusion. She states if in two site and drugs can't run together I am wrong because the is pt with SOB doesn't have enough medical necessity.


:confused:
 
mitchellde said:
Yes you are correct, the E&M code needs a 25 modifier for facility billing just as in physician billing. It could be that the chargemaster does not have the 25 modifier built in or it has two charge codes for each E&M one with the 25 modifier and one without. You should check with the chargemaster department.
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hi

modifier 25
 
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