Wiki Help with ER Coding

[DMC1123]

Any help greatly appreciated.

Thank you

 

[jimbo1231]

Depends

Hi,

I'm guessing you are asking about ED Facility Levels and procedures. Does the hospital have documented guidelines for ED facility levels? Usually they are either a point system or some type of spreadsheet or matrix. And even if we had that, you just can't guess procedures based on the sparse information you provided. but with that disclaimer, I'll take a crack at it.
You also are asking for Principal Diagnosis. I believe that is a hospital coding concept, not ED or outpatient. And you are asking for procedure codes in cases where there diesn't appear to be a procedure.

Case 1 If the patient was admitted to the hopsital the ED code would be roled into the DRG. If the patient is sent to the Cath Lab and then discharged, this scenario is usually in the 99285 range. could also be CC, 99292, but would need documentation to support it imcluding time.

Case 2 If the total between the 2 wrists is 6 CM. you have a 12002. Also you would have to add a 25 modifier to the 99285

Case 3. Was there actually a procedure completed? An E&M Level looks right. But would need to see hospital guidelines and documentation to see if 99285 is right. Also 969.0 requires a 5th digit.

Case 4 If the documentation on the chart the is contusion, elbow, that is the right code. If there is documentation of mechanism of injury on the chart you should also have an E code. 99281 looks undercoded for ED services and resources rendered in this scenario.

Case 5. If the patient was evaluated and manged only, the E&M code is right. Might be a level higher depending on services and resources usedin the ED.

Jim S.