decisionhealth Newsletters, Coder Pink Sheets - 2009 Issue 4 (April)
Handle ‘emergencies’ – and be well paid for doing so
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Article Overview
This article discusses how pediatric offices can handle certain urgent but routine injuries and minor procedures without automatically referring patients to the emergency department. It explains the practice-management and billing context for office-based urgent care, including related evaluation and management reporting, emergency-basis service reporting, and the use of Medicare fee schedule examples for common office-treatable injuries. The piece is aimed at pediatricians, office managers, and coders who want to understand the general scope of these services and the reimbursement implications.
Why This Topic Matters
Office-based handling of selected urgent cases can affect patient convenience, scheduling, and reimbursement while potentially reducing unnecessary emergency department use. Understanding the article helps practices evaluate whether these services fit their workflow and billing processes.
Article Sections
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Office-based urgent care for injuries
Discusses the types of minor injuries and procedures pediatric practices may manage in the office instead of referring patients elsewhere. It also addresses practical considerations for accommodating these visits in a busy practice.
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Billing and reimbursement considerations
Covers the general billing context for office-based urgent procedures, including evaluation and management reporting and emergency-basis service reporting. It also notes payer and reimbursement issues that may arise in office billing.
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Common injuries and Medicare fee schedule examples
Presents a table of representative injury-related procedures and associated Medicare fee schedule examples from 2009. The section serves as a reference for the kinds of services discussed in the article.
What You Will Learn
- How some pediatric practices manage minor urgent injuries in the office
- What billing and reimbursement topics are associated with those services
- Which general categories of office-treatable injuries are highlighted by the article
- How the article uses Medicare fee schedule examples to illustrate office-based care
Who Should Read This
- Pediatricians
- Primary care clinicians
- Medical coders
- Biller/coding staff
- Practice managers
Codes Discussed
Modifiers Discussed
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