Nirali H.

Patel, MD Pediatric Emergency Medicine Children’s Hospital Medical Center of Akron


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4 1 3 1 2

years of Medical School year of Research years of Pediatric Residency year of Pediatric Chief Resident years of Pediatric Emergency Fellowship

Total: 11 Years of Medical Experience

Estimate 80 hours work week (conservative!)
80 hrs x 52 weeks/yr x 11 yr 45,760 hours

A: 0-10 hours B: 11-20 hours C: 21-30 hours D: 31-40 hours .

 Article published May 2010 in Western Journal of Emergency Medicine ◦ Surveyed 34 EM residents and 22 EM attendings regarding overall comfort of billing and coding ◦ 91% of Residents and 95% of Attendings felt that their jobs will require knowledge in billing & coding ◦ Only 26% and 29% felt they had adequate education in billing and documentation during residency .

Includes orthopaedic procedures. surgical and diagnostic procedures performed in the ED are considered separate services for coding purposes. laceration repairs. According to a 2004 Article in Emergency Medicine Clinics of North America.   . foreign body removals. CPR. A billable service is one listed in the CPT manual that is performed as described.

◦ Secure nonemergent injuries to bones until they can be evaluated by orthopaedics. Decrease movement Provide support and comfort through stabilization of an injury. Uses Support and protect injured bones and soft tissue. swelling. Reduce pain. ◦ ◦ ◦ ◦ . and muscle spasm.

splints can be adjusted to accommodate swelling from injuries easier than enclosed casts. Advantages & Disadvantages ◦ Unlike casts. However. . since injuries are often acute and continued swelling can occur. ◦ Splints or "half-casts" provide less support than casts. splints are noncircumferential and often preferred in the emergency department setting.

 Methods ◦ Custom Made: especially if an exact fit is necessary. and to put on and take off due to velcro straps . ◦ Ready-made splint:     Off-the-shelf splints Variety of shapes and sizes Easier and faster to use Easy to adjust.

        Finger Splints Thumb Spica Splint Volar Splint Dorsal Splint Teardrop Splint Boxer Splint Reverse Sugar Tong Elbow Splint .

    Knee Immobilizer Ankle Stirrup Posterior Ankle Posterior Leg .

 Laceration coding depends on three variables ◦ Repair complexity ◦ Wound location ◦ Wound size .

◦ Simple ◦ Intermediate ◦ Complex . CPT groups laceration repairs broadly into three categories. by extent of repair.

APC 0133) involve ◦ ◦ ◦ ◦ Epidermis Dermis Subcutaneous Tissue No signifiant involvement of deeper tissue. . Simple (singlelayer) repairs (12001-12018.

◦ Layered closure. Intermediate repairs (12031-12057. ◦ Heavily contaminated wounds requiring extensive cleaning may qualify as an intermediate repair. even if single layer sutures. . APCs 0133 and 0134) involve ◦ Deeper layers  Subcutaneous tissue  Superficial (non-muscle) fascia  Skin (epidermal and dermal) closure.

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APCs 0134 and 0135) ◦ Involve more than layered closure  Extensive undermining  Stents  Retention sutures ◦ Extensive revision or repair of traumatic lacerations ◦ Avulsions ◦ Reconstructive or creation of a defect to be repaired (scar excision with subsequent closure). Complex repairs (13100-13153. .

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external genitalia. axillae. CPT categorizes wounds by anatomic location. and/or extremities (including hands and feet). trunk. For example. Within each level of repair. simple repair codes 1200112007 apply to wounds of the neck.  .

 Determine code choice according to repair complexity and anatomic location for each wound Then select final code according to the size of the repaired wound(s).  .

“cumulative” wound ◦ Choose one code only to describe two or more repairs of the same severity in the same anatomic category. . Multiple Wounds ◦ CPT treats all repairs of the same severity and within the same anatomic classification as a single.

select 12034 Repair. 7. axillae.5 cm . trunk and/or extremities [excluding hands and feet]. Example ◦ Surgeon repairs lacerations on both hands (3 cm and 5 cm) and the left arm (9 cm). add together the individual 3-cm and 5-cm lacerations for a total size of 8 cm ◦ Report 12044: Repair. feet and/or external genitalia. 7. intermediate. wounds of neck.6 cm to 12. hands.6 cm to 12 cm ◦ For the arm wound. ◦ To report repair of the hand wounds. intermediate. ◦ All repairs qualify as intermediate because the physician must remove particulate matter from the wounds. wounds of scalp. in addition to simple closure.

 Traumas or Cardio respiratory Arrests Chaotic Documentation Includes ◦ ◦ ◦ ◦ Intubations Central Lines Intraosseous Lines Thoracocentesis and Thoracotomy Tubes   .

 In the ED. will not be an elective intubation. Emergent intubation usually preceded by Rapid Sequence Intubation (RSI)  .

not for elective intubation ◦ Documentation should support an emergent need through appropriate coding  Critical care codes ◦ Intubations are considered separately billable procedures from critical care services ◦ Must subtract the time you spend on these procedures from the time you bill for critical care services . Endotracheal intubation. emergency (CPT 31500) ◦ Use this code in emergency or crisis situations.

 Multiple Sites Requires Sterile Site   Associated with more risks and complications Usually requires a specialist  .

 When IV access has failed Does not require sterilization or specialist   Used to rapidly obtain access .

 Used for air in the lungs causing difficulty breathing (Tension Pneumothorax) .

pleural effusion) or large pneumothorax Sterile procedure May be done under conscious sedation in stable patients or while patient is intubated during resuscitation   . For blood or fluid in the lungs or lung lining (hemothorax.