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Thread: ED coding professional side

  1. #1

    Default ED coding professional side

    AAPC: Back to School
    I have a couple of question about coding for the professional side of the Ed. I know you use code range 99281-99285 but do you also code for the x-rays and ekg and lac repairs or does the hospital just pick them up? Also when you using the marshfield audit for the HPI and you have two or three different levels for the HPI do you take the lowest or middle or how does that work.

    Thank you

  2. #2

    Default e/m coding

    When coding for the professional side you would code the e/m and other procedures that were performed.


    99285 25

    10061 (I & D)


    However, if you were to code just the ekg you would not use the 25 modifier.

  3. #3
    Join Date
    Apr 2007
    Milwaukee WI

    Default ER visit codes

    ER visit codes require all three elements meet or exceed the code guidelines.

    So if you have a detailed history, a problem focused exam, and low level decision making you have to go with the LOWEST - in this case the problem focused exam won't let you code anything higher than a 99281.

    If your ED physician is performing the lac repair or I&D, by all means code that (don't forget your -25 modifier on the E/M). As for Xrays - you'll want to ONLY code for the professional component, as the hospital will code for the technical compoonent.

    F Tessa Bartels, CPC, CEMC
    Last edited by FTessaBartels; 06-16-2009 at 01:39 PM.

  4. #4
    Join Date
    Apr 2007
    Columbia, MO


    Be careful about coding the professional component or even the EKG interpretation, mos hospitals have radio;ogiss that provide the xray interpretation so the ED physician would not code that and if the tracing were sent to a cardiologist for interpretation the ED physician would not get that one either. In the ED I was in the physician got the E&M and any procedures the performed, but diagnostic were the hospitals.

  5. #5
    Join Date
    Apr 2007
    Lauderdale Lakes, FL


    Below find a very interesting "view" on the billing of the professional component of x-rays/EKG by the ER physician:

    Under current Medicare policy, when a professional interpretation of an X-ray
    or EKG does not contribute to the diagnosis and treatment of the emergency patient, then such interpretation is not deemed to be medically necessary and is not reimbursable under Medicare.’ The Health Care Financing Administration (“HCFA”) assumes that an interpretation performed by a
    cardiologist or radiologist “contemporaneously” with the diagnosis and treatment of an emergency patient “directly contributes” to such diagnosis and treatment. According to HCFA, an interpretation that is provided “days or hours” after the patient is sent home does not meet this requirement. Rather, HCFA view such services as quality control activities. Thus, any interpretation that is not performed contemporaneously is not medically necessary. Billing for non-medically necessary services can carry severe
    consequences. It is even possible that submission of a claim for such services might be viewed as submission of a false claim.

    If a hospital bills for the professional component of an X-ray or EKG, the
    hospital should ensure that it complies with the Medicare rules and bills only for the interpretation that was medically necessary. Attempts by the hospital to circumvent the Medicare rules by ensuring that only one bill is submitted to HCFA could potentially be deemed to be fraudulent behavior if HCFA were to discover that the hospital submitted bills for professional interpretations that did not contribute to the diagnosis and treatment of the patient and did not allow emergency physicians to bill for the interpretations that did contribute to the diagnosis and treatment of the patient.

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