Medicare Compliance & Reimbursement - 2009 Issue 2
Reader Questions: ED Claims Cannot Contain EBV Screens
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Article Overview
This short Q&A explains how an emergency department encounter involving suspected mononucleosis and an EBV-related diagnostic screen is treated for coding purposes. It is aimed at ED coders, billing staff, and revenue cycle professionals who need to understand the distinction between professional and facility billing in a hospital-based setting. The article includes general guidance on E/M reporting, the screening test, and the diagnosis classification referenced in the scenario.
Why This Topic Matters
It helps readers determine whether a diagnostic screen can be billed separately on the physician claim in the ED and how the related visit is reported at a high level.
Article Sections
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Question
Presents the clinical scenario and asks how the encounter and related testing should be coded in the emergency department setting.
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Answer
Explains the general coding approach for the encounter and discusses how the screening service is handled in the ED versus the office setting.
What You Will Learn
- How an emergency department visit involving suspected mononucleosis is discussed from a coding perspective.
- How the article distinguishes professional billing from hospital facility billing for a related screening test.
- What general type of evaluation and management reporting is referenced for the encounter.
- How the diagnosis referenced in the scenario is handled at a broad level.
Who Should Read This
- Emergency department coders
- Hospital billing staff
- Physician practice coders
- Revenue cycle professionals
- Compliance staff
Codes Discussed
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