Tag Archives: emergency
Posted on 14. Jun, 2010 by Editor.
When scouring the notes for evidence of an emergency department caveat scenario, coders can easily forget to ask themselves one simple question: Can I report a critical care code for this scenario?
The answer’s yes more often than you might think, says Caral Edelberg, CPC, CPMA, CCS-P, CHC, president of Edelberg Compliance Associates in Baton Rouge, La.
“Many patients who qualify for the caveat may also be candidates for critical care. If the condition is severe enough that the patient’s ability to provide this information is impaired, then the condition may be critical,” she explains.
Critical Care Omits Specific History Component
Considering critical care and the caveat simultaneously can make your head spin, as the ED caveat
Posted on 30. Apr, 2010 by Editor.
A patient reports to the emergency department in such severe respiratory distress that she cannot communicate during the history of present illness (HPI) portion of the E/M service. The patient also presents to the ED alone via ambulance, meaning there was no one else to speak for her.
How can a coder decide on the history level for this ED E/M service? Knowing an important exception to the HPI rules in ED settings will help you accurately report these incidents.
When a physician documents that an HPI [history of present illness] is unobtainable due to patient condition, you can invoke the caveat, explains Lori Bettencourt, CPC, PCS, coder at Pro-Medbill LLC in Hampton N.H.
Benefit: The ED caveat can prevent E/M downcoding based on the E/M HPI component. Follow this FAQ to get the lowdown on all the ED caveat rules you’ll need to code correctly each time.
Posted on 17. Jan, 2010 by sanjay.aikat.
Question: A 60-year-old patient reports to the ED with a bandaged left hand. The patient says she was cleaning out the blades of her snow blower and cut her left index finger; the wound is wrapped in gauze, but it is reddening with blood. During an expanded problem focused history and exam, the physician undresses the wound, applies pressure and ice to stop the bleeding, and cleans it using Betadine. During the E/M service, the physician notes a laceration to the index finger but no signs of infection. Using Dermabond, the physician closes a 2.7 cm laceration on the patient’s finger. How should I code this encounter?
Posted on 03. Dec, 2009 by .
When your physician performs a FAST (focused assessment by sonography for trauma) examination, be sure to go through the notes slowly or you could miss one of the three common codes.
FAST exam patients are almost always in some physical trauma, which requires a high-level E/M service; once the physician makes the decision, she’ll perform a pair of procedures to complete the FAST exam.
Use this guide to correct coding so you’ll be quick on the draw when coding for trauma patients requiring FAST exams in your Emergency Department.
Posted on 17. Nov, 2009 by sanjay.aikat.
Question: A 42-year-old patient reports to the ED early on Tuesday morning for evaluation of uncontrollable shaking in her extremities and severe pain in her neck. The EP admits the patient to observation at 7 a.m. and orders blood tests and a CT scan — however, the shaking continues to worsen. The EP consults with a neurologist, who recommends hospitalization. The neurologist then admits the patient to the hospital as an inpatient at 6:25 p.m. Tuesday for more examination. Notes indicate a comprehensive history and exam, along with moderate medical decision making. Should I code this as an observation, or some other E/M service?
Answer: The ED physician could use an initial observation code in this situation.
On the claim, report 99235 (Observation or initial hospital care, …) for the E/M with 781.0 (Abnormal involuntary movements) and 723.1 (Cervicalgia) appended to represent the patient’s symptoms. ED physicians do not admit patients to hospital inpatient status (though they can recommend hospitalization); the neurologist will code for those services.
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Posted on 29. Jun, 2009 by .
Patients often report to the ED with multiple lacerations — and coding will vary depending on several factors.
Remember: “The location and type of closure will tell you whether to add [the repairs] together or use separate codes,” says Kevin Arnold, CPC, business manager for the Emergency Medicine Department at Connecticut’s Norwalk Hospital. Check out these brief case studies so you can cut to the quick when coding more than one laceration fix on the same patient.
Case 1: Cuts of the Same Severity, Location
The first step in coding multi-laceration repairs is to “look to the type of closures; if they are the same type … and both repairs are located in the same anatomical location, then you would add them together,” explains Arnold.
For example, the ED physician performs a 2.1 cm intermediate repair on a patient’s left ear, and an intermediate 3.4 cm repair on her left cheek.
In this instance, you would add the repair lengths (2.1 + 3.4 = 5.5) and choose 12053 (Repair, intermediate, wounds of face, ears, eyelids, nose, lips, and/or mucous membranes; 5.1 cm to 7.5 cm) for the encounter.
Case 2: Cuts of Differing Severity, Same Locale
If the patient has lacerations in the same anatomical grouping, but the severity differs, report a code for each repair, Arnold confirms. For example, the ED physician performs intermediate repair of a 2.3 cm cut on a patient’s right shoulder, and a simple repair of a 3.4 cm laceration on the patient’s lower back.
In this instance, you would report the following:
Posted on 27. Feb, 2009 by .
Although CPT offers two observation code sets, and encounters that look like observations may actually be other E/M services, your observation coding can be spot-on every time simply by following this five-step plan.
Step 1: Confirm Type of E/M Service
Before coding, be sure that the service qualifies as an observation. “Observation is a hospital-based outpatient service used to determine if a patient needs inpatient care. Most payers limit the time a patient may be in observation status to 23 hours, though some (Georgia Medicaid, for example) allow as long as 48 hours,” explains Jeffrey Linzer Sr., MD, FAAP, FACEP, associate medical director for compliance at Emergency Pediatric Group Children’s Healthcare of Atlanta at Egleston.
So when you’re reviewing the notes, ensure claim correctness by checking the encounter specifics against Linzer’s observation definition.
Posted on 26. Feb, 2009 by .
If you cannot spot simple or complicated foreign body removal (FBR) qualifiers, you could end up costing the ED more than $80 for a simple removal, or more than double that per complex episode. Galvanize your soft-tissue FBR coding skills with this expert advice.
Follow CPT for FBR Definition
Coding for soft-tissue FBRs seems simple enough: A patient reports to the ED with an FB, the physician removes it, and you choose an FBR CPT code.
Not so fast: The above scenario might be an FBR, but it might also be an E/M service. To report one of the soft-tissue FBR codes, the encounter should fit the following description, from Joshua Tepperberg, CPC, EMT-D: The provider makes an incision to the overlying skin, and then removes the FB.