Medical Coding Training: Get Your Facts Right on Emergency Department FAST Exams


Emergency and trauma medicine keeps on changing, as demonstrated in the development of the focused abdominal sonography for trauma (FAST) exam. These exams are mainly effective because so many trauma patients have injuries that providers do not discover during the initial triage intake in the ED or trauma area. Read this expert medical coding and billing article for more.

We'd never used ultrasonography during trauma. We would actually have to put a catheter into someone's abdomen and then determine the, you know, and look at the amount of blood coming out.

We would sometimes - we even send it to the labs to determine how many thousands of red blood cells there are in that. And you would actually do a diagnostic perineal lavage as it was called. And you're not seeing this, a lot.

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And the reason you don't is because it was pretty inexact. It was certainly a procedure that you did enter someone's belly and so consequently, it was one that was (found) with potential problems. But when you have something like the ultrasound now it's really made a mark difference in the way we look at that.

Fast exam really is looking both at the chest and the abdomen. Remember, if you're in a motor vehicle accident, you can certainly damage your chest. You can certainly - it can remarkably damage your abdomen and the number of organs that are there. So let me just kind of go through it with you so you have an idea.

You're looking  in the abdomen there are three locations you look at in the fast exam. There's a space between the liver and the kidney, between the liver and the kidney which is in the right upper quadrant. We should say really the really side, if you will, because right upper quadrant but more towards the side of the individual. We are actually looking for blood within the space between the liver and the kidney. So that's on the one hand.

You may start there. You're going to swing to the other side and looking then between the spleen and the kidney. So between that there's a potential sac between those two areas. And you do want to look for blood which appears - it's more black-looking on an ultrasound or fluid. You know, fluid that's gathered looks more black in the ultrasound. So those two sites would be the first initial sites you would go to.

Third site would be over the bladder area. So you'd be down and above the pubic bone, looking in the bladder area. And once again, more than likely if there's blood down there, you would see a crescent shaped area right above the bladder itself. And that crescent would be again black again. And that would be more again, in the occasion that there's blood there. So those are three main locations you look at in the abdomen.

And by the way, the medical coding option would be 76705 for the abdominal component of the fast exam. For the chest component, you have to kind of visualize this or maybe even feel it. If you go and you feel your breast bone and you go all the way down to the bottom of it heading toward the abdomen, that's called the epigastric area, there's xiphoid. It's really the end of our sternum.

The ultrasound, you know, is really pressed there and you're aiming towards the heart. So, maybe in the upper abdomen but you're actually evaluating the surrounding sac of the heart called the pericardium. What you're looking for would be blood in the pericardium because that could indicate there's been a puncture or tear in the heart itself which creates again, blood around the heart. It's called pericardial effusion but that effusion is a hemopericardium or blood around the heart.

Now, that particular component of which is the fourth area you're looking in the fast exam is the chest component and that's a 93308. 93308 would be the ultrasound code that you would use. So, when you're billing for fast exam, you would be using two medical coding options -- the 76705 and the 93308 for the fast exam once again following trauma.

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