Emergency Department Coding - AHIMA

[Pages:37]Emergency Department Coding

Audio Seminar/Webinar

October 2, 2007

Practical Tools for Seminar Learning

? Copyright 2007 American Health Information Management Association. All rights reserved.

Disclaimer

The American Health Information Management Association makes no representation or guarantee with respect to the contents herein and specifically disclaims any implied guarantee of suitability for any specific purpose. AHIMA has no liability or responsibility to any person or entity with respect to any loss or damage caused by the use of this audio seminar, including but not limited to any loss of revenue, interruption of service, loss of business, or indirect damages resulting from the use of this program. AHIMA makes no guarantee that the use of this program will prevent differences of opinion or disputes with Medicare or other third party payers as to the amount that will be paid to providers of service.

CPT? five digit codes, nomenclature, and other data are copyright 2006 American Medical Association. All Rights Reserved. No fee schedules, basic units, relative values or related listings are included in CPT. The AMA assumes no liability for the data contained herein.

As a provider of continuing education, the American Health Information Management Association (AHIMA) must assure balance, independence, objectivity and scientific rigor in all of its endeavors. AHIMA is solely responsible for control of program objectives and content and the selection of presenters. All speakers and planning committee members are expected to disclose to the audience: (1) any significant financial interest or other relationships with the manufacturer(s) or provider(s) of any commercial product(s) or services(s) discussed in an educational presentation; (2) any significant financial interest or other relationship with any companies providing commercial support for the activity; and (3) if the presentation will include discussion of investigational or unlabeled uses of a product. The intent of this requirement is not to prevent a speaker with commercial affiliations from presenting, but rather to provide the participants with information from which they may make their own judgments.

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Faculty

Lynda Starbuck, MS, RHIA

Ms. Starbuck is the national manager of auditing and education for Smart Documentation Solutions (SDS) Healthport. Lynda has over 15 years experience in ED coding, RBRVS, evaluation and management, and proper physician and nursing documentation to aid in ED coding and compliance.

Becky Wilson, CCS, CPC

Ms. Wilson is a senior emergency department auditor with Healthcare Coding and Consulting Services (HCCS). Ms. Wilson has seven years of experience in emergency department coding, and has been an auditor of emergency department records for four years.

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Table of Contents

Disclaimer ..................................................................................................................... i

Faculty .........................................................................................................................ii

Objectives ..................................................................................................................... 1

OPPS ? Facility Charge Guidelines.................................................................................... 1 E/M Determination ................................................................................................ 2 Critical Care .......................................................................................................... 3 Cardiopulmonary Resuscitation ............................................................................... 3 Intubation ............................................................................................................ 4 Burns ................................................................................................................... 4 Rule of 9s...................................................................................................... 5 Three Types of Burns ..................................................................................... 7 Burn Treatments............................................................................................ 7 Polling Question #1 ............................................................................................... 8 Fracture Care Services ........................................................................................... 8 Splints and Strapping ..................................................................................... 9 When to Code Splints (facility) .......................................................................10 ED Treatment Rooms ...........................................................................................11 Polling Question #2 ..............................................................................................11

Problem ED Procedures I and Ds ..............................................................................................................12 Suture Repairs .....................................................................................................12 Fish Hook Removal...............................................................................................13

IV Hierarchy .................................................................................................................13 Documentation ....................................................................................................14 IV Coding Decision Trees ......................................................................................14

2008 ICD-9-CM Diagnosis Codes Herpes Simplex ....................................................................................................16 Coronary Atherosclerosis.......................................................................................16 Avian Influenza Virus ............................................................................................17 Dysphagia ...........................................................................................................17 Ascites ................................................................................................................18 Personal History Codes .........................................................................................18 Family History Codes ............................................................................................19 Old Codes Worth Mentioning .................................................................................19

Medical Necessity ..........................................................................................................20 Supporting Coding References...............................................................................21

Modifiers ...................................................................................................................21 Modifier -25 .........................................................................................................22 Modifier -52 .........................................................................................................22 Modifier -59 .........................................................................................................23 Anatomical Modifiers ............................................................................................23

OPPS Changes for 2008 .................................................................................................24

CMS-2008 E/M Guideline Direction..................................................................................24

Case Study #1 ..............................................................................................................25

Case Study #2 ..............................................................................................................25

Case Study #3 ..............................................................................................................26

Case Study #4 ..............................................................................................................26

Resources ...................................................................................................................27

Audience Questions

Appendix ..................................................................................................................31

CE Certificate Instructions .....................................................................................32

AHIMA 2007 Audio Seminar Series

Table of Contents

AHIMA 2007 Audio Seminar Series

Emergency Department Coding

Notes/Comments/Questions

Objectives

What's included in Critical Care, CPR, and Intubation and Fracture Care for facilities

Proper Burn Coding

When to code Splints and Strapping

What's considered a Treatment Room

Identify Problem Procedures

Guidance for Facility E/M

Simplify IV Coding

Identify New Diagnosis Codes Pertaining to the ER

Understand Coding for Medical Necessity

Proper Use of Modifiers

OPPS and how it affects you in FY 2008

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OPPS ? Facility Charge Guidelines

In the outpatient arena of healthcare, CMS moved to a system much like DRGs called APCs. The difference is that only one DRG is paid, whereas multiple APC payments may be made for one visit.

CMS continues to try to construct facility E/M levels to reflect the acuity of care patients receive (national guidelines). Until then, each hospital is allowed to construct their own facility levels based on the acuity of care patients receive and to some extent the resources provided.

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CPT? Codes Copyright 2006 by AMA. All Rights Reserved

Emergency Department Coding

Notes/Comments/Questions

Facility Charge Guidelines

CMS ? moving away from fee for service OPPS/APCs ? caused restructuring of ED

levels Facility levels reflect the acuity of care the

patient receives Status indicator ? describes how services

are treated under OPPS for hospital outpatient departments

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Facility E/M Determination

Five levels ? CPT 99281 ? 99285

Critical care ? CPT 99291 ? code also any procedures performed

Third party payers may not pay additional ? hours of critical care on the facility side

All procedures performed by physicians and ancillary staff must be coded

Review nursing notes for procedures performed

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CPT? Codes Copyright 2006 by AMA. All Rights Reserved

Emergency Department Coding

Notes/Comments/Questions

Critical Care

Beginning in 2007, nurses must also document duration of critical care time in order to charge E/M 99291. (Less than 30 minutes of care does not support critical care)

Remember ? if it is not documented, it did not happen.

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Cardiopulmonary Resuscitation

Cardiopulmonary Resuscitation (CPT 92950) found in cardiac arrest only includes the actual bagging of the patient and external cardiac massage.

Drugs given during cardiac resuscitation should be coded separately using CPT 90774 / 90775.

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CPT? Codes Copyright 2006 by AMA. All Rights Reserved

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