Health Information Management

Quiz: Emergency department coding

HIM-HIPAA Insider, December 6, 2005

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How well do you know your emergency department (ED) coding rules and regulations? Take this three-part quiz and find out.

Question 1: We sometimes use our ED in a clinic-type manner, but we do not have an outpatient clinic in our facility. What CPT code should we bill when a patient arrives at our ED with an order, or the patient's physician calls in an order, to change or insert a Foley catheter? We generally perform normal workup on the patient and the nurse takes the patient's information, checks his or her vital signs, and performs a brief assessment before inserting the catheter.

Question 2: A patient who currently takes Coumadin® presents to the ED with a 1 cm laceration/avulsion on the tip of his finger. A physician uses chemical cautery to stop the bleeding. The CPT Manual states that a simple laceration repair includes repair with chemical or electrocautery. The 2005 Coding Companion for Emergency Medicine, p. 29 states, "Coding tips-Wounds treated with cleansing, irrigation, and control of bleeding qualify as a simple repair even if they are not closed with sutures." Given these references, can I code 12001, or would the E/M code include the procedure?

Question 3: What does the APC reimbursement include for an ED patient that requires an orthopedic intervention, splint, cast, or crutches?

Answer 1: Do not charge an emergency room visit for this type of service. Register these patients as outpatients as opposed to emergency room patients since they are being directed to your ED for routine and not emergency services. Develop a separate set of visit charges and criteria that will allow you to classify and bill for these visits. According to the UB-92 editor, assign a 510 revenue code to these clinic visits. This will reflect a clinic-type visit in an outpatient department, which more accurately describes the service the provider performs. Use CPT codes in the 99201-99205 range for a new patient and in the 99211-99215 range for an established patient. Ensure that you also have a full complement of possible procedures that physicians could perform in this setting. For example, if a patient is scheduled for an immunization or other type of injection, report the injection codes 90782-90788 or 90471-90472 instead of the clinic-visit code.

Answer 2: Yes, assign 12001 for the simple wound repair when a physician performs the chemical cautery for the scenario described above. The CPT subsection notes under "simple repair" specifically state that a physician uses a simple repair when the wound is superficial and involves primarily the epidermis, dermis, or subcutaneous tissue without further significant involvement of deeper structures. This includes local anesthesia and chemical or electrocauterization of wounds not closed.

Answer 3: CMS intends to compensate for the application of orthopedic devices by way of the facility reimbursement, which covers the resources the facility expends, including the staff time it takes to apply the device; overhead such as electricity, square footage, supplies, packaged drugs, and equipment; the time it takes the provider to evaluate the device's placement; and the staff time it takes to provide the patient with instructions.

Editor's note: This article was adapted from, published by HCPro, Inc.

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