優化您的RVU和腐敗修複

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以下是如何加強您的圖表和報銷。

For most emergency clinicians, providing high-quality care for our patients with lacerations is built into our DNA. Having a keen proficiency in wound management is just what we were trained to do. However, for many of us, our training did not include learning the skills of how to fully detail our service in this area. In order to get properly paid for our work, we do need to be vigilant here. In 2021, the reality is our careers and longevity in Emergency Medicine relies on our ability to chart effectively. This article will show you how to optimize your reimbursement with laceration repairs.

並非所有撕裂都是平等的


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這是真的。必須考慮許多因素。撕裂長度,傷口汙染,異物去除,修複層和可生長的組織都融入了遊戲。這些因素不僅影響您的治療方法,而且影響您為您提供的潛在財務回報。不要忽視關心的價值。請務必詳細了解您的文檔中的所有傷痕護理和縫合修複幹預措施。您的報銷潛力可能大於您的想法。

Make Sure You Are Focused

幾起tips to help optimize reimbursement with your wound repairs:


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  • 不要估計傷口長度。大多數臨床醫生傾向於估計損傷長度。因此,測量所有損傷維修。每次撕裂,每次都會感到驚訝。
  • 如上所述,“始終衡量”撕裂,但而且而且measure after they are repaired。Interestingly, AMA CPT guidelines specify it is the measuredrepairedwound length that should be reported.[1]
  • Finally,記錄後的損傷長度應保持一致among all providers who are involved in a particular patient’s care. When working with your Advanced Practice Providers and resident physician colleagues, make certain you are all reporting the same lengths.

Additional Caveats with Laceration Repair

There are some important delineation points in laceration repair: 0 – 2.5 cm/2.6 cmto 5.0/5.1厘米到7.5 /7.6 cm到12.5厘米。保持警惕並適當地測量傷口閉合。請記住,當多個傷口(假設如下所述的相同分類類別)在同一解剖部位內修複時,將纏繞長度加到一起並分配一個代表性的CPT代碼。您的拋棄修理會加起來。最後,始終注意這些重要細節:傷口的位置,任何“大量清潔”,顆粒物質的去除,卷繞邊緣的清織物,傷口邊緣(“有限”或“廣泛”)和簡單的與分層閉合。

There is a Difference in the Details

The service you provide and your ability to properly detail that service does make a difference. For example, a single-layer laceration repair of a 2.4 cm leg wound reimburses 1.30 RVUs = $ 45.36, as paid by Medicare. This categorized as a “simple repair,” CPT 12001 simple repair of superficial extremity wound, up to 2.5 cm.


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Alternatively, compare this to a multi-layer laceration repair of a 3.4 cm leg wound that also requires debridement of its wound edges. This categorized as a “complex repair,” CPT 13121 complex repair of extremity wound, 2.6 cm to 7.5 cm. This repair reimburses 7.51 RVUs = $ 262.05 as paid by Medicare. These figures are based on the 2021 Medicare Physician Fee Schedule, in which 1 RVU = $ 34.89.[2]

正如您所看到的,修複的複雜性確實會影響您提供的服務的潛在報銷。還記得許多私人保險公司報銷更高。這是Catch - 沒有在您的文檔中提供合適的細節,您的報銷是無處不在的。您有效地繪製的能力確實會影響您的底線。

Good to Know – 3 Key Levels of Wound Repair

The following categories are how Emergency Medicine coders “think” to properly code your encounters:

1)“簡單”損傷修複=>涉及單層閉合。

2)“中間”損傷修複=>涉及廣泛的清潔,除去顆粒物質,限製削弱和/或多層閉合。

3)“複雜的”損傷修複=>通常涉及多層封閉和額外的幹預措施,包括:a)缺乏可生長的傷口邊緣或b)任何“廣泛破壞”。

These designations of simple, intermediate or complex in laceration repair indeed matter — distinct RVUs (and associated levels of reimbursement) are assigned for each.

The definition of “limited” vs. “extensive” undermining does warrant special mention. “Extensive” undermining is defined as “a distance greater than or equal to the maximum width of the defect, measured perpendicular to the closure line along at least one entire edge of the defect”. Here’s the translation for Emergency clinicians – i.e. your procedure note should look like this: “The 10 cm thigh laceration was examined and had a maximal width of 1.5 cm. The wound’s edges were under considerable tension andextensive underminingwas required. Therefore, using a #11 blade, 1.5 cm of undermining was performed along its entire medial wound edge.”

在側麵上,“有限”泄漏涉及修理,其中從傷口的邊緣破壞到小於損傷本身的最大寬度的距離。(即“在上麵的例子中”在上麵的例子中進行了0.5厘米的破壞)我對進入編碼雜草的道歉!在任何情況下,這將使您的程序作為“中間”修複。

How to Chart (and Reimburse) Optimally with Laceration Repairs:

  • “傷口受到汙垢顆粒和需要的大量灌溉的嚴重汙染。”=>“中間”修複。
  • “Using forceps, I removed several wood particles from the wound.” => “intermediate” repair.
  • “Lower Leg 8 cm Laceration Multi-layer Repair…the subcutaneous tissue was closed using 4-0 vicryl, six buried horizontal mattress sutures. Next the skin was closed using 4-0 nylon, 16 simple interrupted sutures…” => “intermediate” and potentially “complex” repair.
  • “傷口的橫向邊緣被競相和不規則。因此,這個邊緣需要使用虹膜剪刀的清卓人和修訂。“=>“複雜”修複,與多層閉合相關聯。

保持清晰的文檔,您可以實現您提供的服務的適當返回。更好地文件,更好地報銷 - 這是您在急診醫學中償還成功的關鍵。

ABOUT THE AUTHOR

Dan Magdziarz,Do,是芝加哥帕洛斯醫院的緊急醫生。他也是ChartOptima.com的首席執行官和創始人:2018急救醫學償還教學網站。您可以在Twitter @emreimbursement上關注。分享您的興趣和評論:dmagdziarz@chartoptima.com

2評論

  1. 賈斯汀•托馬斯

    Does the time involved with the wound repair play a role in reimbursement? I’ve heard from other colleagues you need a minimum amount of time to bill for your procedure, but I have yet to find any collaborating information.

  2. Thanks for your question – in non-teaching practices (those not involving resident physicians), the time involved in wound repair does not factor into reimbursement (i.e. laceration repair CPT codes are not timed based). Critical Care and Moderate Sedation CPT codes / services are among the most common time-based services emergency physicians provide in everyday practice.

    您的同事可能會提及涉及居民醫師的腐敗修複。根據ACEP報銷常見問題解答(2月2021年)=>“對於輕微的外科手術(持續不到五分鍾),教學醫師必須在整個服務期間物理出現。對於重大程序(持續超過五分鍾),教學醫師必須在服務的“關鍵部分”期間物理存在,並且必須立即在整個程序中提供服務。“在這些情況下,時間確實存在。

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