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Thread Topic: Emergency Room coding question
Topic Originator: Joyce
Post Date May 10, 2011 @ 3:50 PM
Emergency Room coding question


Joyce
May 10, 2011 @ 3:50 PM Reply  |  Email Friend   |  |Print  |  Top

I'm new to ER coding and I have a question.  I'm trying to find support in the record for 83880  85610  85730 of a Medicare patient.  The patient came into the ER with shortness of breath.  This would support these tests. However, the definitive dx was COPD, which does not.

Is it appropriate to use the SOB rather than the COPD? The patient's initial symptoms are what prompted the tests in the first place.

steve Verno
May 10, 2011 @ 9:17 PM Reply  |  Email Friend   |  |Print  |  Top

What you have to follow is what the ED provider documented in the medical record.  

You may have XXXXX, YYYYY, ZZZZZ, and 999.99 may support these codes, but if 999.99 is not documented, it doesnt exist and we cant use it.  Also, if XXXXX, YYYYY, nd ZZZZZ is not documented, the same is with 999.99.  if the doctor documents 888.88 and 888.88 doesnt support XXXXX, YYYYY, then we use what IS documented.  If that means we have nothing to support XXXXX, YYYYY and ZZZZ, then that is it.  

As an example, a patient presents with ear pain.  You want to code 12001, but ear pain doesnt support an open wound repair. so you cant report 12001.  The question is why did the doctor document a wound repair when the patient had ear pain???  Something doesnt add up.  Ive had an insurance company tell me to submit a code for a shoulder dislocation when the patient had  fractured ankle and the doctor treated the fractured ankle.  The insurance company said they wont pay for the ankle, they would pay a dislocated shoulder.  I said i cant report what didnt happen and an ankle is a heck of a lot different than a shoulder.  I did get the claim paid reporting the ankle fracture.  I sent the claim with a atrongly worded letter to the CEO of the insurance company.  

Steve Verno, CEMCS, Certified Emergency Medicine Coding specialist
Emergency Medicine Specialists.  
Heal Your Practice

Steve Verno
May 10, 2011 @ 9:33 PM Reply  |  Email Friend   |  |Print  |  Top

I forgot to add, per coding guidelines, which do not support emergency medicine, if the doctor wrote COPD as the definitive dx, then the dx is COPD. The guidelines say we do not report a symptom that is part of a definitive diagnosis.  Ive written many letter to have this changed for emergency medicine.  

An example I use is.  

57 year old obese male presents with chest pain (786.50)  The docto does an EKG.  The EKG doesnt reveal a cardiac event.  CPK-MB does not indicate heart attack.  Other tests reveal the patient has a peptic ulcer. Chest pain is a symptom of the definitive diagnosis but a peptic ulcer isnt a valid reason to do an EKG. Chest pain is and chest pain is the presenting medical complaint.  Under current coding guidelines, we should not report the EKG.  The peptic ulcer will get the claim denied by the HMO as not being an emergency as defined by EMTALA.  This is why emergency medicine must have separate rules  to allow reporting of symptoms even when those symptoms are part of the definitive diagnosis.  

Another example.  a 22 year old single mother has a 3 year old child. It is 2am on Saturday morning on a holiday weekend.  The mother's HMO wont be open until Tuesday.  the child has been crying nonstop since 6pm.  The mother is at her ends wits and she hates seeing her child in pain and suffering.  She brings the child to the emergency room.  The doctor diagnoses her with otitis media.  Otis Media is not life threatening and no loss of life or limb will happen.  Ear pain is a symptom of the definitive diagnosis of otitis media.  Again, under current coding guidelines, we cant use ear pain even though pain is an emergency.  The HMO will deny the claim saying it wasnt an emergency and the mother/child could have waited until Tuesday.  This is a decision made by an armchair HMO bureaucrat, who probably doesnt have children and  who is trying to save the HMO money so they can get their 6 figure bonus.  If we can use ear pain in addition to the OM, we can justify the ER visit and the emergency.  I see these all the time.  

Ive had the medical director of an HMO deny fractures, beatings, and cardiac arrest as being non-emergencies.    Off the record, when I code emergencies, if the reason the patient presented and it is documented that the patient came to the ED with SOB, I code the symptom of SOB, but, this is off the record.  I must show this as the reason why the patient came to the ER and it must be documented.  yes, this goes against current coding guidelines, but again, these guidelines do not take emergency medicine into consideration, which is why I am working to have this changed.  Officially, I must use the current coding guidelines and report the definitive diagnosis and I cant report any symptom that is part of the definitive diagnosis.  From a compliance standpoint, I must state that we follow current coding guidelines.

Joyce
May 10, 2011 @ 11:16 PM Reply  |  Email Friend   |  |Print  |  Top

Wow - Thank you, thank you!!! You've given me so much to think about and consider.  This truly is something that should be changed (in my entirely amateur opinion!!).

I really appreciate the examples.  They speak volumes.

Stephanie
December 11, 2012 @ 7:44 PM Reply  |  Email Friend   |  |Print  |  Top

I am starting as an er coder IV at a hospital I have my icd10 and cpt and also got emergency room made easy icd10. In this book it has actual er charts which I would be coding from but I am very confused on the letters. I know x has to be used for a dummy for a 7 digit but she has burn T22.21 I'm not getting where the T or the other code are coming from I don't see it in the tabular. Please please help me

Josh
December 12, 2012 @ 6:52 AM Reply  |  Email Friend   |  |Print  |  Top

ICD-10 is not a current valid code set in the US.  ICD-10 does not become effective until October 2014.

Steve Verno, CMBSI, CEMCS, CMSCS, MCS
December 22, 2012 @ 9:03 AM Reply  |  Email Friend   |  |Print  |  Top

Stephanie

the official ICD-10-CM manual hasnt been published yet.  ICD-10-CM wont be effective until October 1, 2014.  The process of Coding ICD-10 will be similar to coding ICD-9-CM.  Ive created ICD-10-CM guides for some specialties.  Emergency care is one of them.  if you're trying to train yourself, that is excellent, but selecting the true codes wont take place for many months to come.  When ee get near Oct 1, 2014, that is when you will see the actual icd-10-cm manual published.  This way when you look up T22-21, you will see second degree burn of the forearm. I dont know if this is what is documented and as a coder, I never ever code from what someone writes on a forum.  This is because a coder must be 100% true accurate and complete.  A coder can only code from the medical record document, not a 4 paragraph post which starts with Xyear old presents with.....  Once ICD-10 becomes effective coders are going to be very busy with their own coding and appealing carrier coding denials.  Many forums are no longer providing coding answers and some are informing the visitor that the forum is not the place to properly code.  The process of coding wont change.  The codes will change.  What you see today may change by 2014.  As an emergency coder, what Ive seen of ICD-10 isnt going to be scary.  Chest pain is chest pain,  786.50 is what will change.  For now 786.50 becomes R07.89.  A burn will still be a burn, the number is what will change.  You will still use the same process to look up a code.  When ICD-10-CM becomes effective, that X may be replaced in the published manual, but we wont know for 23 months.  To become a better coder, I recommend undergoing training rather than trying to teach yourself.  If you know the basics, the transition wont be difficult.  Ive been looking at ICD-10 for 3 years now and it isnt scary at all.  Ive been with emergency care for 40 years.  Even coding emergency care under ICD-9 isnt easy.  100% is reading the charts.  One way to succeed is to not overfill your mind.  If you reaqd too much into something you become confused.  I keep everything simple.  I dont do what if.  I look at what I have and that is what I stick to.  Ive had students ask me, What if...  There is no what if.  WYSIWYG (What you see is what you get). But, again, the official final codes have not been published. The guidebooks I created were given to BC Advantage.  They are free.  Again, ICD-10-CM wont happen until October 2014.  You have time to go to school, become certified and then say, I know that!!!

Much success

Steve Verno, CMBSI, CEMCS, CMSCS, CPM-MCS
Certified Medical Billing Specialist Instructor
Certified Emergency Medicine Coding Specialist
Certified Multispecialty Coding Specialist
Ceritifed Practice Manager-Medical Coding Specialist
Retired Registered Emergency Medical Technician
Retired American Red Cross Health & Safety Instructor Trainer
Professor - Medical Coding & Billing - Everest University (Medical leave)
Coding and Billing Advisor - Professional Association of Healthcare Coding Specialists (PAHCS)
Coding and Billing Adviusor - National Center for Competency Testing
Coding and Billing Advisor - Federal Trade Commisssion
Coding and Billing Advisor - Physician Office Managers Association of America (POMAA)
Coding and Billing Advisor - Lake-Sumter Medical Society
Coding and Billing Instructor - The Coding Institute and Audio Educators.
Member - Medical Economics Committee - Florida College of Emergency Medicine.

Steve Verno, CMBSI, CEMCS, CMSCS, MCS
December 22, 2012 @ 9:25 AM Reply  |  Email Friend   |  |Print  |  Top

Stephanie

the official ICD-10-CM manual hasnt been published yet.  ICD-10-CM wont be effective until October 1, 2014.  The process of Coding ICD-10 will be similar to coding ICD-9-CM.  Ive created ICD-10-CM guides for some specialties.  Emergency care is one of them.  if you're trying to train yourself, that is excellent, but selecting the true codes wont take place for many months to come.  When ee get near Oct 1, 2014, that is when you will see the actual icd-10-cm manual published.  This way when you look up T22-21, you will see second degree burn of the forearm. I dont know if this is what is documented and as a coder, I never ever code from what someone writes on a forum.  This is because a coder must be 100% true accurate and complete.  A coder can only code from the medical record document, not a 4 paragraph post which starts with Xyear old presents with.....  Once ICD-10 becomes effective coders are going to be very busy with their own coding and appealing carrier coding denials.  Many forums are no longer providing coding answers and some are informing the visitor that the forum is not the place to properly code.  The process of coding wont change.  The codes will change.  What you see today may change by 2014.  As an emergency coder, what Ive seen of ICD-10 isnt going to be scary.  Chest pain is chest pain,  786.50 is what will change.  For now 786.50 becomes R07.89.  A burn will still be a burn, the number is what will change.  You will still use the same process to look up a code.  When ICD-10-CM becomes effective, that X may be replaced in the published manual, but we wont know for 23 months.  To become a better coder, I recommend undergoing training rather than trying to teach yourself.  If you know the basics, the transition wont be difficult.  Ive been looking at ICD-10 for 3 years now and it isnt scary at all.  Ive been with emergency care for 40 years.  Even coding emergency care under ICD-9 isnt easy.  100% is reading the charts.  One way to succeed is to not overfill your mind.  If you reaqd too much into something you become confused.  I keep everything simple.  I dont do what if.  I look at what I have and that is what I stick to.  Ive had students ask me, What if...  There is no what if.  WYSIWYG (What you see is what you get). But, again, the official final codes have not been published. The guidebooks I created were given to BC Advantage.  They are free.  Again, ICD-10-CM wont happen until October 2014.  You have time to go to school, become certified and then say, I know that!!!

Much success

Steve Verno, CMBSI, CEMCS, CMSCS, CPM-MCS
Certified Medical Billing Specialist Instructor
Certified Emergency Medicine Coding Specialist
Certified Multispecialty Coding Specialist
Ceritifed Practice Manager-Medical Coding Specialist
Retired Registered Emergency Medical Technician
Retired American Red Cross Health & Safety Instructor Trainer
Professor - Medical Coding & Billing - Everest University (Medical leave)
Coding and Billing Advisor - Professional Association of Healthcare Coding Specialists (PAHCS)
Coding and Billing Adviusor - National Center for Competency Testing
Coding and Billing Advisor - Federal Trade Commisssion
Coding and Billing Advisor - Physician Office Managers Association of America (POMAA)
Coding and Billing Advisor - Lake-Sumter Medical Society
Coding and Billing Instructor - The Coding Institute and Audio Educators.
Member - Medical Economics Committee - Florida College of Emergency Medicine.



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