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Re: [MedicalBillers] ER visit with surgical supplies

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  • debbie brosnan
    Amen to that!!! There are several examples in the review book that are incorrect. In the Kidney section. The problem was a laparoscopic ablation of renal
    Message 1 of 17 , May 31, 2007
      Amen to that!!! There are several examples in the review book that are incorrect. In the Kidney section. The problem was a laparoscopic ablation of renal cyst. I coded it as 50541. the answer key said 50546 rephrectomy. I sure wouldnt want to go to that dr.

      B Burgess <granbfly@...> wrote: Well, I guess if the test question actually gave you low for MDM, then the "correct" answer would be 99282 because you need all three of history, exam and mdm so you would have to go with the low mdm to drive your level of service. I think they just goofed....... maybe they were focusing on the fact that the treatment was restriction of activity and/or the fact that it was an uncomplicated injury. That would put it low on the table of risk along with the fact that you probably only had one point for radiology in data review.(although they didn't even mention an xray in the example) Realistically, you still have a new problem (3 points) and prescription drug (mod table of risk) which gives you a moderate mdm. I would even challenge that the injury could be considered an "acute complicated injury" since it was a fracture and requred splinting. The example give for "uncomplicated injury" is a sprain not a fracture. I just got back
      from an E/M conference where it was said
      that almost any ER visit would be moderate to high on the MDM and seldom ever lower than that. Patients presenting to the ER are either "treated and streeted" (1 new problem with prescription) or admitted (1 new problem with further workup and surgery or potentially life threatening condition) Of course, sometimes my being a nurse gets in the way of my being a coder. My clinical judgement and interpretations make it easier for me when I have to meet with the physicians to discuss their audits, but sometimes makes me less objective when I'm coding, especially with E/M.

      I also sat for the ACS-E/M exam a week ago and was glad that I took the course offered first which was given by the person who wrote the exam. I absolutely did NOT agree with some of her views, but for exam purposes, I was able to answer the questions her way. Doesn't mean they were right, just means I was able to do well on the exam.

      Barbar Burgess, RN, CPC

      debbie brosnan <thebiller_2000@...> wrote:
      I absolutely agree, I coded it 99284. However the answer key says 99282. I tried to contact the acadamy to explain their answer, no one returned my call. I take the test in 16 days.

      B Burgess <granbfly@...> wrote: That would be a 99284 (IMHO). The medical decision making would actually be moderate, not low. You have a new problem with no additional work up and prescription drug management. That would made the MDM mod so with the detailed history and exam you would have a 99284.

      Barbara Burgess, RN, CPC

      debbie brosnan <thebiller_2000@...> wrote:
      I didnt realize Ca doesnt use Rev codes. how the heck do you identify the ancillary services? Lab, xray, supplies, drugs, implants, you know the usual stuff that goes along with a normal patient care. I am in Michigan, we have quirky rules too. I have heard that if you can bill in Ca and Michigan you can bill anywhere.

      Ok, here is my question. I am taking the CPC exam in 16 days. there is a scenerio (sorry cant spell) in my practice book that goes like this.

      The patient is brought to the ED with a broken collar bone, The injury was sustained from a fall while rock climbing in the mountains. The dr performs a detailed history and exam. The bone is splinte dwith a firgure 8 splint and the patient is sent home with a prescription of Lortab 7.5 and directions to restrict activity for a few weeks (low decisio making).

      What level would you pick?

      KIMBERLY SIERRA <ms2ks@...> wrote:
      Debbie,

      Thanks again. I also do ER Physician billing. What is your question. As for rev codes because the supplies are being billed under the surgical procedure code with a modifier for supplies the rev code wouldn't be in the 200 range right or wrong? Also Medi-Cal in CA doesn't look at rev codes for out patient billing. But I want to know the correct rev code to link it to for ER. You are luck to have a billers group that gets together. I happen to find this web site by accident but let me say I am glad I found it!

      debbie brosnan <thebiller_2000@...> wrote:
      Kim,

      Supplies dont go on rev code 250. That is a pharamacy code. Use 250 if pt received any drugs. Lactated Ringers or anything administered through IV use 258. Med-Surg supplies go under 270. Sterile supplies use 272. The hospital charge master should have these supplies already linked to the correct Rev Codes.

      Do you do ER Physician billing? or just facility? I have an ER Physician billing question.

      Its always good to be able to bounce questions off of people, we have a state billers group, we meet every 90 days, its a great group of people. Always bouncing stuff off of each other. Everyone knows the insurance company sure isnt going to help us.

      Let me know about the ER question

      Stay on the sunny side of life,

      Deb

      KIMBERLY SIERRA <ms2ks@...> wrote:
      Thank you Debbie Brosnan. That is what I thought would be the correct way to bill the charges out. As for rev codes 450 for ER services? Someone in our thought that the supplies should fall under rev code 250? What do you think?
      Thank
      Kim

      debbie brosnan <thebiller_2000@...> wrote:
      You can bill for both the ED and The procedure since the patient did not come in for the purpose of surgery. Besure to use the correct revenue codes. You can bill for supplies with the correct rev codes for sterile and nonsterile supplies along with drugs. I am not sure if the supplies will be bundled into the APC reimbursment. Be sure to add anesethesia charges if the patient recieved anything other than a local. Did the patient in turn get admitted to recovery? If so besure to add recovery room charge. If the patient recovered in the ED then you cant bill for recovery room. I would treat this the same as a bedside procedure with an ER visit. Please let me know if someone tells you different.

      The physician is going to bill an E/M Mod 25 and the procedure.

      Deb Brosnan, BS

      KIMBERLY SIERRA <ms2ks@...> wrote:
      Hey Everyone,

      I have a question. This has been a heated topic at work. I was wondering if anyone would know where I can find the answer to this question along with documentation. When a patient comes into the ER and the doctor decides to do surgery. Can the hospital bill for a room charge and a separate line for supplies related to the surgery? I am looking for the correct way to bill for Medi-Cal (CA) and Managed Care programs(CA) ? These is for facility charges only the Doc bill will be separate.
      Thanks

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    • KIMBERLY SIERRA
      We use rev codes in CA but Medi-Cal doesn t look at them for out patient services. Medi-cal in CA is different from any other state. They do thing so backwards
      Message 2 of 17 , Jun 2, 2007
        We use rev codes in CA but Medi-Cal doesn't look at them for out patient services. Medi-cal in CA is different from any other state. They do thing so backwards to every other ins here. I think of myself as knowing a foreign language when it comes to them. Medi-cal uses rev codes for in/pt but doesn't except all of them. I do agree I would have said 99282 but I also see the points for 99284. Would have liked to see the report and how detailed it was may have helped.

        Kim

        Debbie brosnan <thebiller_2000@...> wrote:
        I didnt realize Ca doesnt use Rev codes. how the heck do you identify the ancillary services? Lab, xray, supplies, drugs, implants, you know the usual stuff that goes along with a normal patient care. I am in Michigan, we have quirky rules too. I have heard that if you can bill in Ca and Michigan you can bill anywhere.

        Ok, here is my question. I am taking the CPC exam in 16 days. there is a scenerio (sorry cant spell) in my practice book that goes like this.

        The patient is brought to the ED with a broken collar bone, The injury was sustained from a fall while rock climbing in the mountains. The dr performs a detailed history and exam. The bone is splinte dwith a firgure 8 splint and the patient is sent home with a prescription of Lortab 7.5 and directions to restrict activity for a few weeks (low decisio making).

        What level would you pick?

        KIMBERLY SIERRA <ms2ks@...> wrote:
        Debbie,

        Thanks again. I also do ER Physician billing. What is your question. As for rev codes because the supplies are being billed under the surgical procedure code with a modifier for supplies the rev code wouldn't be in the 200 range right or wrong? Also Medi-Cal in CA doesn't look at rev codes for out patient billing. But I want to know the correct rev code to link it to for ER. You are luck to have a billers group that gets together. I happen to find this web site by accident but let me say I am glad I found it!

        debbie brosnan <thebiller_2000@...> wrote:
        Kim,

        Supplies dont go on rev code 250. That is a pharamacy code. Use 250 if pt received any drugs. Lactated Ringers or anything administered through IV use 258. Med-Surg supplies go under 270. Sterile supplies use 272. The hospital charge master should have these supplies already linked to the correct Rev Codes.

        Do you do ER Physician billing? or just facility? I have an ER Physician billing question.

        Its always good to be able to bounce questions off of people, we have a state billers group, we meet every 90 days, its a great group of people. Always bouncing stuff off of each other. Everyone knows the insurance company sure isnt going to help us.

        Let me know about the ER question

        Stay on the sunny side of life,

        Deb

        KIMBERLY SIERRA <ms2ks@...> wrote:
        Thank you Debbie Brosnan. That is what I thought would be the correct way to bill the charges out. As for rev codes 450 for ER services? Someone in our thought that the supplies should fall under rev code 250? What do you think?
        Thank
        Kim

        debbie brosnan <thebiller_2000@...> wrote:
        You can bill for both the ED and The procedure since the patient did not come in for the purpose of surgery. Besure to use the correct revenue codes. You can bill for supplies with the correct rev codes for sterile and nonsterile supplies along with drugs. I am not sure if the supplies will be bundled into the APC reimbursment. Be sure to add anesethesia charges if the patient recieved anything other than a local. Did the patient in turn get admitted to recovery? If so besure to add recovery room charge. If the patient recovered in the ED then you cant bill for recovery room. I would treat this the same as a bedside procedure with an ER visit. Please let me know if someone tells you different.

        The physician is going to bill an E/M Mod 25 and the procedure.

        Deb Brosnan, BS

        KIMBERLY SIERRA <ms2ks@...> wrote:
        Hey Everyone,

        I have a question. This has been a heated topic at work. I was wondering if anyone would know where I can find the answer to this question along with documentation. When a patient comes into the ER and the doctor decides to do surgery. Can the hospital bill for a room charge and a separate line for supplies related to the surgery? I am looking for the correct way to bill for Medi-Cal (CA) and Managed Care programs(CA) ? These is for facility charges only the Doc bill will be separate.
        Thanks

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