Coding, Classification & Reimbursement

1.  ER laceration & level billing

Posted 5 days ago
I have a problem with my facility not knowing should a CAH facility bill laceration charges in the ER. I'm a coder that is trying to seek information on billing for these laceration in the ER department. Can anyone help me with prove to show them that laceration and ER levels can be billed with modifier -25. I have found research on the CMS website for this, but they think that CAH have to bundled those charges, which I have not found anything about that. So can anyone who work at a CAH facility let me know how your facility is billing for these.Thank you!

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Wendy Johnson
Medical Coder
Jefferson Regional Medical Center
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2.  RE: ER laceration & level billing

Posted 4 days ago
Wendy,

I am a coder at a CAH in Kansas and I can tell you that we always bill separately for the laceration repair.  In fact, any other procedure that is not included in the ER triage is billed separately per Medicare's guidelines.  This would include chest tubes, intubation, catheter inserts, splinting, NG tube insert, joint injections/aspirations, epistaxis treatment, ear irrigation, burn care, foreign body removal, I&D, etc.  I can't recall at this moment where the specific guidelines are but they are in the Medicare manual.  Hard to find since that thing is so large!  But I can tell you with certainty that we have never been denied for billing a procedure separately.  Hope this helps!

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Mellissa Heimer, RHIT,CCS
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3.  RE: ER laceration & level billing

Posted 4 days ago
Thank you! I'm going to look some more on CMS website



On Jan 12, 2018 8:51 AM, "Mellissa Heimer via American Health Information Management Association" <Mail@connectedcommunity.org> wrote:
Wendy,  I am a coder at a CAH in Kansas and I can tell you that we always bill separately for the laceration repair.  In fact, any other...
Re: ER laceration & level billing
Reply to Group Reply to Sender
Mellissa Heimer, RHIT,CCS
Jan 12, 2018 9:52 AM
Mellissa Heimer, RHIT,CCS
Wendy, 

I am a coder at a CAH in Kansas and I can tell you that we always bill separately for the laceration repair.  In fact, any other procedure that is not included in the ER triage is billed separately per Medicare's guidelines.  This would include chest tubes, intubation, catheter inserts, splinting, NG tube insert, joint injections/aspirations, epistaxis treatment, ear irrigation, burn care, foreign body removal, I&D, etc.  I can't recall at this moment where the specific guidelines are but they are in the Medicare manual.  Hard to find since that thing is so large!  But I can tell you with certainty that we have never been denied for billing a procedure separately.  Hope this helps!

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Mellissa Heimer, RHIT,CCS
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Original Message------

Wendy,

I am a coder at a CAH in Kansas and I can tell you that we always bill separately for the laceration repair.  In fact, any other procedure that is not included in the ER triage is billed separately per Medicare's guidelines.  This would include chest tubes, intubation, catheter inserts, splinting, NG tube insert, joint injections/aspirations, epistaxis treatment, ear irrigation, burn care, foreign body removal, I&D, etc.  I can't recall at this moment where the specific guidelines are but they are in the Medicare manual.  Hard to find since that thing is so large!  But I can tell you with certainty that we have never been denied for billing a procedure separately.  Hope this helps!

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Mellissa Heimer, RHIT,CCS
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