Reader Questions: Find Responsible Party for Missing ED Patients
Use Protocol for MIA Patients
Question: We have triaged patients who get tired of the waiting room and leave - never having seen the ED physician. How should we handle this? We have been billing a triage fee. The UB-92 states that an attending physician's name has to be on the UB-92 in order to bill the service.
Maryland Subscriber
Answer: The correct way to approach this scenario depends on your facility's preferences and payer guidelines. Under EMTALA, a facility must provide an appropriate medical screening examination to all persons who present themselves to its "dedicated emergency department" (whether on or off the hospital's main campus), and who request an examination or treatment of a medical condition.
If a patient leaves without a physician evaluation and without moving from the waiting room to the examination room, most hospitals choose not to charge at all. This is generally considered a non-billable visit that may be tracked for statistical purposes. If, however, staff brought the patient to an exam room and she leaves before the emergency department physician sees her, some facilities assess a minimal evaluation and management level (or do as otherwise warranted by specific payer contract).
As for the name of the attending physician, you have a couple of options. Some facilities use the name of their medical directors, while others use the name of the emergency physician on duty that day. Reporting the name of the emergency doctor is probably a better choice, because if the claim were to be audited, it's logically more likely that an ED physician would know offhand why the patient never received attention.
Note Location for Cyst Code
Question: The physician excised two sebaceous cysts off of the patient's back. One cyst was 4.7 cm and the other was 3.3 cm. How should I code this?
Oregon Subscriber
Answer: For the 4.7-cm cyst excision, you should assign 11406 (Excision, benign lesion including margins, except skin tag [unless listed elsewhere], trunk, arms or legs; excised diameter over 4.0 cm). You should report 11404 (... excised diameter 3.1. to 4.0 cm) for the physician's removal of the 3.3-cm cyst.
Both 11406 and 11404 are appropriate for three reasons:
You may need to attach modifier -59 to 11404 to show the insurer that the second excision was separate and distinct from the first procedure, but according to National Correct Coding Initiative (NCCI) edits, version 11.0, it is not required.
Report Units for ED Injections
Question: If multiple IM injections are given in an ED, should I report 90782 for each injection, or 90782 with a modifier?
Texas Subscriber
Answer: Generally, you should report the number of units of the injection administered in the emergency department (ED). If a procedure of which 90782 (Therapeutic, prophylactic, or diagnostic injection [specify material injection]; subcutaneous or intramuscular) is a component is also performed during the visit, you may also need to append modifier -59 (Distinct procedural service).
Code Dermabond With G0168
Question: What is the appropriate code to report for application of Dermabond? I know the status indicator for G0168 changed in 2005, but is the intent of the code to describe a procedure or a supply?
Arkansas Subscriber
Answer: The status indicator of G0168 is now "N," meaning it represents an incidental service. This change means you can report the code, but you won't receive any reimbursement for it.
According to CMS, wound adhesives are now considered supplies used for laceration repair, so their costs are packaged into the costs of the procedure.
For more details on why this change took place and further guidelines about reporting G0168, refer to the Federal Register, vol. 69, no. 219, page 65697.
Reader Questions reviewed by Sarah L. Goodman, MBA, CPC-H, CCP, president of SLG Inc. in Raleigh, N.C.
- Published on 2005-03-22
SuperCoder
