UMEM Educational Pearls

Category: Misc

Title: Coding and Billing Pearls

Keywords: Coding, Billing, Reimburshment (PubMed Search)

Posted: 12/16/2007 by Michael Bond, MD (Updated: 7/10/2020)
Click here to contact Michael Bond, MD

The insurance companies are always trying to down code our visits so that they can save money, and unless we diagnosis the patients with the appropriate jargon it can cost us a lot of money.  Here are some coding suggestions as written by Sharon Nicks, President and CEO of Nicks & Associates in EP Monthly .

 

Diagnosis
Consider Diagnosising  It this, if the condition fits
Esophagitis
  • Acute Chest Pain
U.R.I.
  • Acute febrille illness with cough
  • Acute tracheobronchitis
Gastroenteritis
  • Acute severe abdominal pain
  • Acute dehydration (volume depletion) secondary to nausea/vomiting
  • Electrolyte imbalance
 Flu/Viral Ilness
  • Acute viremia
  • Acute febrile illness
 Musculoskeletal Pain
  • Acute cervical pain
  • Acute chest wall syndrome
  • Acute strain or pain to a specific (i.e: lumbar) due to a MVA or fall
Otitis Media
  • Acute febrile illness secondary to acute otitis media
  • Otalagia

 

The moral of this pearl is try to use words like Acute, Severe, Sudden, Serious, Distress, Pain, or Fever so that it is clearer to the insurance companies that the patient warranted a visit to a physician (i.e.: an ED) before their PCP could see them in a week.