Coding, Classification & Reimbursement

ER laceration & level billing

  • 1.  ER laceration & level billing

    Posted 01-11-2018 22:46
    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 01-12-2018 09:52
    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 01-12-2018 16:43
    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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  • 4.  RE: ER laceration & level billing

    Posted 02-02-2018 04:13
    Edited by Jack Sycz 02-02-2018 04:14
    Hi Wendy.

    The question to ask is: Does an office visit cover this?

    A laceration repair is ABSOLUTELY Separately identifiable because its not like it was pre-scheduled ahead and knowing that it has to be done. This has to have some examination before a course of treatment can be made.

    You would want to list the surgical code for the lac repair first, (10000-10999 series)

    The only time you would include [bundle] the lac repair is if it was part of another procedure. A skin biopsy, for example always includes simple closure and the local anesthesia.

    I hope that helps..


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    Jack Sycz, Jr., CCA
    Seasonal HCC Coder
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