tci ED Coding & Reimbursement Alert - 2004 Issue 12

Reader Question: Include Controlled Substances in MDM

Question: What standard should I follow when claiming fracture care with an E/M code? I realize that pain control is included in fracture care, but what if the physician gives a parenteral-controlled substance? Does that increase the risk as well as the level? North Dakota Subscriber Answer: If the physician provides services meeting the definition of conscious sedation, he could bill for that service - as long as the procedure was not included on the list in Appendix G of the 2005 CPT book (see story on front page, "Think Twice Before Billing for ED Ultrasounds," for a...

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