[sidebar]Navigate the CPT maze, optimizing your reimbursement[/sidebar]
Editor’s Note: Cutting through the red tape to make certain that you get paid for every dollar you earn has become more difficult than ever, particularly in our current climate of health care reform and ICD-10 transition. The ACEP Coding and Nomenclature Committee has partnered with ACEP Now to provide you with practical, impactful tips to help you navigate through this coding and reimbursement maze.
Don’t overlook sedation services provided by the emergency physician solely or in support of another clinician, such as an orthopedist. Fill out your hospital’s conscious sedation forms and submit these to your coders to document the necessary information to bill for these services. The initial moderate sedation code covers the first 30 minutes of intraservice time, defined as the continuous time from when meds are first given until your personal contact ends. (This code is fulfilled after at least 16 minutes are performed and documented.) After 30 minutes, a code for every additional 15-minute increment can be used (fulfilled after a minimum of eight minutes). When calculating the total sedation time, be sure to only include the minutes involved in direct face-to-face monitoring of the patient. Do not include any separately identifiable evaluation and management service prior to sedation or the time it took for the patient to recover from the sedation while being monitored by a nurse. For example, when a clinician goes into a room to reduce a shoulder, there is some preparatory discussion and exam. When the sedating agent is given by the physician, that is the beginning of the intraservice time. The shoulder is then reduced. The clinician stays a few minutes to ensure the patient’s mental status improves, then the physician leaves the room. When the physician leaves the room, that is the end of the intraservice time. If the total intraservice time is 16 minutes or more, then the sedation codes can be used.
Brought to you by the ACEP Coding and Nomenclature Committee.
Dr. Leigh is a practicing academic emergency physician at the Cleveland Clinic Akron General Campus in Ohio. Dr. Lempert is vice president and medical director, health care financial services, at TeamHealth, based in Knoxville, Tennessee.