Title: Coding for Trauma and Emergency Medicine

Title: Coding for Trauma and Emergency Medicine Presenter: Darlene Boschert RHIA, CPC, CPC-H, CPC-I

Objective: Participants can expect to learn about new issues in coding for trauma and emergency medicine, the importance of documentation, the use of time in critical care coding, surgical packages and specialties in the emergency department.

Presentation/Summary: - Learn what’s new - What to do when you’re unable to obtain history - Learn bottom-up coding - Critical care – the heart of emergency medicine - What and what not to include in critical care coding - Learn the definition of the surgical package - Coding for Orthopedic in the emergency department - EKG, X-ray and Rhythm Strip interpretations

Target audience: - Physicians - Coding professionals - Billing/Reimbursement specialists

1) True or false. If the patient is unconscious and unable to provide medical history to the emergency department staff then it is sufficient for the provider to notate the reason why and move on with treating the patient. a) True b) False

2) According to the risk table on slide 10, which of the following diagnostic procedures is an example of would be ordered to be able to support a moderate level of risk? a) Chest x-ray b) Cardiac electrophysiological test c) Clinical lab tests, w/arterial puncture d) Obtaining fluid from a body cavity

3) Which code/s would be used to indicate 75-104 of critical care time? a) 99291 b) 99291 + 99292 x 1 c) 99291 + 99292 x 2 d) 99291 + 99292 x 3

4) Which of the following is an untrue statement regarding critical care time and codes. a) Time spent with the patient needs to be continuous to charge all critical care codes b) Count only those activities/interventions that relate to the patient c) Use 99291 to report the first 30-74 minutes of critical care on a given date. It should be used only once per date even if the time spent by the physician is not continuous on that date. d) The critical care codes 99291 and 99292 are used to report the total duration of time spent by a physician providing critical care services to a critically ill or critically injured patient, even if the time spent by the physician on that date is not continuous

5) Which of the following is true regarding the use of a defibrillator? a) Can be billed using code 92960 b) Not reportable as an isolated procedure c) Is a planned event d) Assists the circulation of a patient using external chest compression

6) What modifier would be used to indicate the initial management of a fracture and not the follow-up care? a) 24 b) 25 c) 54 d) 55

7) The surgical package includes a related E/M encounter (subsequent to the decision for surgery). At what stage is that encounter included in the surgical package? a) It is never included in the surgical package b) It is only included when a modifier is attached to the E/M code c) It is included when done no less than 3 days prior to the surgery d) It is included immediately prior to or on the date of the surgery

8) Which of the following is not included in the Medicare procedure package? a) Post-op pain management by the surgeon b) Intraoperative services that are usual and necessary part of the surgical package c) Diagnostic tests and procedures d) Supplies and related services

9) True or false. A temporary cast/splint/strap is considered to be a part of pre-operative care and the use of the modifier 56 is appropriate in this circumstance. a) True b) False

10) An EKG interpretation should include a minimum number of elements (e.g. rhythm or rate, axis, intervals, ST segment change, comparison to prior EKG, summary of clinical condition). What is the number suggested by Darlene? a) 3 of 6 elements b) 4 of 6 elements c) 5 of 6 elements d) 6 of 6 elements