Coding Cues: Reimbursement for post-ED care

May 16, 2008

Our family practice routinely sees patients after they've been treated in the ED for lacerations, fractures, and similar injuries. We've recently seen an increase in claim denials for such services because the ED physicians are billing for complete care for procedures, even though we're doing the follow-up. What can we do?

Key Points

Our family practice routinely sees patients after they've been treated in the ED for lacerations, fractures, and similar injuries. We've recently seen an increase in claim denials for such services because the ED physicians are billing for complete care for procedures, even though we're doing the follow-up. What can we do?

Ideally, the ED should attach the modifier –54 (surgical care only) to any billed procedure that has a global period, since follow-up for fracture care or a significant laceration repair generally doesn't involve a subsequent ED visit.

Explain the situation to the person responsible for ED billing services and ask for help in resolving it. If you're dealing with multiple hospitals, request a meeting at each facility, starting with the one with the greatest volume of claim denials for follow-up care.

The author, vice president of operations for Reed Medical Systems in Monroe, MI, has more than 30 years' experience as a practice management consultant, as well as being a certified coding specialist, certified compliance officer, and a certified medical assistant.