JustCoding’s Guide to Emergency Department Coding

The emergency department (ED) is a fast-paced environment that presents unique coding and billing challenges. Department operating hours, missing patient information or nonspecific documentation, and a lack of standardized guidelines for facility E/M leveling make coding for ED services a difficult task. In addition, confusion over CPT^® coding guidelines can result in payer audits and lost revenue.

JustCoding’s Guide to Emergency Department Coding will help coders by clearly explaining how to interpret CPT codes and coding guidelines to accurately report procedures performed in the ED and billed by the facility. The book guides coders through assigning the most specific CPT E/M codes for both physician and facility services. It also offers detailed CPT coding and reporting guidance for integumentary and musculoskeletal procedures commonly provided in the ED and billed by the facility. The final chapter breaks down complex documentation and coding requirements for hospital intravenous injection and infusion services.

All five chapters include figures and real-life case scenarios to give coders hands-on practice and refine their skills.

This book:

• Provides a solid understanding of anatomical terminology and CPT coding guidelines
• Reviews facility and physician E/M visit leveling, and code selection based on accepted standards
• Details CPT coding for integumentary, musculoskeletal, and injection and infusion procedures
• Offers examples, clinical scenarios, and detailed illustrations 

Click here to access chapter previews.

Published: July 2019

Page count: 138
ISBN: 978-1-68308-922-3

Table of Contents

Introduction

Chapter 1: Professional Evaluation and Management
History
Physical Examination
Medical Decision-Making
Critical Care
Professional E/M Summary

Chapter 2: Facility Evaluation and Management
Type A ED
Type B ED
Facility ED Documentation and Leveling
Critical Care
Trauma Activation
Facility E/M Summary

Chapter 3: Integumentary System
Anatomy of the Skin Incision and Drainage (10060–10180)
Debridement (11000–11047, 11004–11008, 11010–11012, 11042–11047)
Wound Repairs (12001–13160)
Burns, Local Treatment (16000–16036)

Chapter 4: Musculoskeletal System
Injection (Tendons, Muscles, Trigger Point) (20526–20553) 
Arthrocentesis (20600–20611)
Fractures
Dislocations
Shoulder (23500–23680)
Humerus (Upper Arm) and Elbow (24500–24685)
Forearm and Wrist (25500–25695)
Hands and Fingers (26600–26785)
Pelvic and Hip Joint (27193–27269)
Femur (Thigh Region) and Knee Joint (27500–27566)
Leg (Tibia and Fibula) and Ankle Joint (27750–27848)
Foot and Toes (28400–28675)
Application of Casts and Strapping (29000–29799)

Chapter 5: Injections and Infusions
Initial Drug Administration Services    
Injection and Infusion Hierarchy
Infusions
IV Push
Hydration
Subcutaneous and Intramuscular Injections
Documentation and Billing Considerations

About the Authors

Nena Scott, PhD, MSEd, RHIA, CCS, CCS-P, CCDS, AHIMA-approved ICD-10-CM/PCS trainer, has served as an educator in the healthcare industry across numerous organizations over the past two decades. She has over 12 years of management experience, a combined 17 years educating, and 28 years of coding and auditing experience.

Her current role with TrustHCS as director of coding quality and professional development includes overseeing coding quality for more than 500 coders and managing internal and external educational offerings. She previously served as a program director and lead instructor for an HIM department. During this time, she created and implemented a registered health information technology program at a community college in northern Mississippi. 

Scott has also performed coding compliance audits for hospital inpatient, outpatient, and provider-based departments. Her engagements with other HIM professionals have focused on guiding coding efforts to increase accuracy and timeliness.

Scott recently obtained a doctoral degree in education. She has been honored by the Mississippi Health Information Management Association with the Champion Award (2010), Educator Award (2009), and Distinguished Member Award (2007).

William L. Malm, ND, RN, CRCR, CMAS, is a managing director at Health Revenue Integrity Services in Cleveland, Ohio, and Melbourne, Australia. He is a nationally recognized author and speaker on topics such as value-based care, healthcare compliance, chargemasters, and CMS recovery audits.

Malm also brings a decade of experience with payer acute care audits. He has more than 25 years of experience with a combination of clinical and financial healthcare knowledge that encompasses all aspects of revenue integrity. Previously, Malm played a key role in providing revenue integrity and data expertise for Craneware PLC. He also serves as the president for the Certification Council of Medical Auditors.

He has extensive experience with all pre- and post-payment audits, having worked as a systems compliance officer at a large for-profit healthcare system. Malm also cohosts Appeal Academy’s “Finally Friday” discussions.

Chapter Previews

Check out these chapter previews for a full idea of what you can expect!