billing.

Reportedly K codes + H112/H113 are rejected

Billing must ALWAYS reflect your documentation

• G codes = describe the life threatening issue, start/stop times

• Comprehensive codes (H1_2) = intermittent attendance over multiple hours

• Reassessments (H1_4) = must be 2h apart and not disposition making

• Written consultation needed for H055 or H065

• Counseling codes (K005/K013/K015/K023/K028) = 20min (1 unit) or 46min (2 unit), document start/stop times

  • K015 requires documentation of who was present in family meeting (i.e. relationship to patient)

• Telephone consults (K73_) must be ≥10 min, document staff name, document start/stop times

• Sedation premiums (see below) - document to justify premium

G5 codes (organ failure or imminent deterioration)

• Cannot bill with
  IV lines, cutdowns, A-lines, central lines, ABG/VBG, pressure infusion sets/drugs
  ETT, toilet, NG, Foley
  Defib/cardioversion 

• Denied by MOH

  • Z341A ($76.80) - chest tube/pigtail

  • G270A ($23.90) - IO

  • G303A ($51.25) - transthoracic pacing

Many procedures can be billed with G5 codes - most commonly:

• • POCUS codes as seen below (usually H100)

  • Z590/Z591 ($31.30/57.65)- paracentesis (Z590 = diagnostic only, Z591 = therapeutic)

  • Z804 ($74.35) - LP (don't forget E871+25% if 2nd attempt US guided)

  • Z331/Z332 ($32.45/59.15)- thoracentesis (Z331 = diagnostic only, Z332 = therapeutic)

  • Z443A ($154.10) - transvenous pacing

  • Z401A ($131.70) - pericardiocentesis

  • G210A - therapeutic hypothermia

  • M137A ($390.65) - thoracotomy; R765A ($231.30) - open cardiac massage

G3 codes (potential threat to life/limb & without intervention, will need G5)

• Same as above, except these are allowed

• • • Z437 ($92.45) electrical or chemical cardioversion

    • G303 ($51.25) - transthoracic pacing

    • Z341 ($76.80) - chest tube/pigtail

• • E412 for evenings (17-24h), weekends & holidays (7-24h) = +20% of the procedure

  • E413 for all nights (0-7h) = +40% of the procedure

Common Forgotten Procedures

• • G435 ($5.10) - Tonometry

  • G403 ($21.15) - Epley

  • Z314 ($11.50) - Unilateral nasal cauterization

  • G384 ($8.85) - Trigger point injection (+G385 for each subsequent x2)

  • Z608 ($58.65) - Foley manual irrigation

  • G921 ($12.50) - Headache Sphenopalatine Block

  • Nerve blocks - cannot bill with procedure, EXCEPT if long-acting (e.g. bupivicaine): 

    • G224A ($15.55) - major or minor peripheral nerve block for post-op pain control, duration ≥4h   

    • G260 ($80.00) - major plexus (e.g. femoral/obturator/lateral fem cutaneous 3 in 1 block)

      • G243 ($54.65) - femoral nerve, unilateral

  • Z363 ($20.00) -  removal of thoracostomy tube (chest tube)

  • Z804 ($150.00) - lumbar puncture

POCUS - must archive

• • H100 ($19.65, max 2/d) - only for pericardial effusion, cardiac standstill, FAST, AAA, ectopic

    • G580A ($45.00) for insertion of probe - TEE

  • J149 ($36.85) - US guided aspiration, drainage (can apply to nerve block)

Document reason for call in on every chart (i.e. volume or sick)

• • Apply travel premium once (to first patient)

    •  H960A – Weekdays ($36.40)

    • H962A – Evenings ($36.40)

    • H964A – Nights ($36.40)

    • H963A – Weekends and Holidays ($36.40)

  • Apply “first person seen” only to first patient

    • H980A – Weekdays ($20.00)

    • H984A – Evenings ($60.00)

    • H986A – Nights ($100.00)

    • H988A – Weekends and Holidays ($75.00)

  • Apply “additional person seen” premiums to each patient afterwards

    • H981A – Weekdays ($20.00) - Up to 4

    • H985A – Evenings ($60.00)- Up to 4

    • H987A – Nights ($100.00)-  Unlimited

    • H989A – Weekends and Holidays ($75.00) - Up to 9

  • Reassessments billable with H1#4 codes (H104A, H134A, H124A, H154A)

If called in early, go back to normal billing once your shift starts