UMEM Educational Pearls

Title: Coding and Billing Pearls

Category: Misc

Keywords: Coding, Billing, Reimburshment (PubMed Search)

Posted: 12/16/2007 by Michael Bond, MD (Updated: 11/22/2024)
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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.