tci ED Coding & Reimbursement Alert - 2002 Issue 7

Caution: Verify Medical Necessity Before Reporting Common Codes

Because Medicare's "incident-to" rules don't apply in a hospital setting, coders who aren't ED experts could be making some costly errors.It's not unusual for patients in the ED to undergo nasogastric (NG) tube insertion, urinary catheterization, and other routine procedures. However, nursing staff typically perform these services, and reimbursement is included in the facility-side payment. Therefore, an established pattern of coding the professional fees may constitute fraud. Five types of procedures are particularly problematic, says Todd Thomas, CCP, CCS-P, president of Thomas and Associates in Oklahoma City: 91105 Gastric intubation, and aspiration or lavage for treatment (e.g...

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