Coder’s Corner: Coding/Billing/Clues

posted in: Issue #2 | 0

These tips are offered by coding and billing experts within the FSED industry. In the reality where insurance companies pick and choose what diagnosis they consider to be emergencies and secretly set “customary charge levels” we hope to assist emergency physicians in actually getting paid for their work by avoiding down-coding.


What documentation is needed to capture suture removal reimbursement?

You only need to document a very simple H&P to get the level needed for recheck reimbursement.

For example: Patient returns for removal of sutures placed 10 days ago. There is no pain or complication at the site of the repair. Wound is healing as expected. There is no drainage or erythema at the site. Sutures removed without complication.


Will specifying the type of headache (i.e. migraine, tension, complex etc. ha) be helpful?

Yes the more specificity the better! We also look for associated signs and symptoms that may be better listed as the primary diagnosis (i.e. persistent vomiting; nausea; aura; etc.).


Does using the word “ACUTE” still help?

Yes, ACUTE is crucial! Many diagnoses in the ICD-9 Manual will direct the coders to assign a chronic or unspecified code in the absence of an “ACUTE” diagnosis.


Would “acute elbow pain” or “evaluate for fracture of elbow” be better than using “nursemaids elbow”?

We can’t code a dx that includes “evaluate for..”; coders will pull pain from the HPI in addition to the nursemaids elbow diagnosis. We have to code nursemaids elbow if a reduction was performed.


Would “volume depletion” or “acute gastroenteritis” be considered a better diagnosis than nausea and vomiting?

Yes both are very specific and important for the final impression of the record, if appropriate. Coders may pull nausea and vomiting to help support the treatments provided, if necessary.


Is “cutaneous abscess” better than “periapical abscess?”

There are very specific codes for abscesses in ICD-9 and CPT. It is important to be as specific as possible. Some payers do not like to see dental conditions reported in the ER and may get denied as being not medically necessary. The coders will look for documentation of jaw pain, facial swelling, etc. to list as a primary code.


Is “lumbar strain” better than “backache”?

Anything is better than backache! Document strain if it is appropriate.


Is “evaluate for sepsis” or “fever of unknown origin” better than “fever”?

It is important for the physicians to document what conditions they are considering as the differential diagnoses is considered. This helps with the medical decision making for the e/m level. Coders will review the record as a whole and will pull another diagnosis to list first if it available (i.e. weakness).


Is “evaluate for acute MI” considered an emergency diagnosis?

We would code the signs and symptoms that supported the urgency of the visit and the workup performed (i.e. chest pain).

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