Coding and Compliance: Get the Expert Advice on Diagnostic Studies in the ED


Read the following professional advice given by our coding expert in a medical coding conference and ensure cleaner ED claims.

Most frequently performed ED ultrasounds and their documentation

So the most frequent really is the - it all depends obviously. If you're a trauma center, your most frequent one would be the fast exam. And it would really be documented. The fast exam, you know, reveals negative sign of any blood within the abdomen and negative blood around the pericardium as an example.

They might very well separate those locations but under most circumstances, the interpretation would probably say “No blood found within the abdominal area and no blood around the pericardial sac.” That would be the most common in a trauma center.

In non-trauma center, it may very well be the non-pregnant uterus or the pregnant uterus. Obstetrical versus non-obstetrical would be very common. Then gallbladder will probably be right up there with them. A lot of individuals have right upper quadrant abdominal pain which could very well be gallstones or cholecystitis. So we would say that probably those are the most common ones. You really have to do a procedural analysis report at multiple occasions to determine the exact numbers but those are the most common ones.

Who gets paid when both the ED physician and the radiologist read the x-ray?

That’s going to be variable. Usually it's going to be the one that has submitted that claim first. So if you've got competing individuals who are submitting their claim, it usually is the first one that submits the claim.

Who is that? It depends. It just depends on who has a more efficient medical coding and billing operation. That would indicate which one would get sent. Very rarely do, you know, if you get two bills, it's pretty rare. You know, only one is going to be paid. And usually what happens is the first one that comes through will be paid. It does a slip through where both get paid. Yeah, it does occur but that occur where they've actually gone back and you know, got refunds from the individual who go in second.

We've not seen a lot of request from different payers for the treatment records themselves to verify who the one that interpreted contemporaneous is. Usually however, it's the first one that gets the claim.

Medical Coding Training Pointers: Remember, EKGs are certainly very commonly billed. X-ray interpretations are not uncommonly billed. Rhythm strips are not commonly billed so I'd be careful about billing for those.

As far as ultrasonography, the obstetrical, non-obstetrical and the abdominal, ultrasounds are more common. But you're going to find coming up here over the next couple of years is vascular access, you know, medical coding option 76937 will definitely be, you know, be started to utilize more and more.

You're going to find a lot more physicians certainly graduating from residency programs. So ultrasonography just by that alone will increase. And a lot of physician groups that are becoming - that each of the individual emergency physicians are becoming certified in ultrasonography.

Difference between an x-ray interpretation and a review

Next to interpretation is really one that's done primarily by the emergency physician where you have a document where the emergency physician states, you know, that the, “You know, my interpretation indicates, you know, that there's no evidence of any pneumonia (inaudible).” Let's say it's a chest x-ray, “There's no evidence of any fluid. No evidence of any (media sty) and a widening. There's no evidence of any pneumonia, no evidence of any bony infiltrates or whatever in the ribs themselves.” That would be one example.

Whether it is interpreted primarily by the emergency physician, whether it was interpreted by the radiologist, whether there's a review with the radiologist, you’d want to look for that and look for the “interpreted by me”.

When you're having a review of an x-ray, you're really reviewing what the radiologist had interpreted. So you really are many times dictating what you might have had a conversation or frankly, you might have had it within the electronic medical record, we can actually see what the radiologist interpreted.

And some of you frankly may have facilities where the radiologist actually faxes their interpretation to you. So you might just see the emergency physician send x-ray interpretation by radiologist indicates blah, blah, blah. But yeah, that's the being the way that's it's held. You're looking for a check box in the template but you're also looking - or looking for the physician stating the “My interpretation indicates”.

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