322-0543 EMERGENCY DEPARTMENT RECORD FORM rev 05-07
322-0543 EMERGENCY DEPARTMENT RECORD FORM rev 05-07
322-0543 EMERGENCY DEPARTMENT RECORD FORM rev 05-07
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HILO MEDICAL CENTER<strong>EMERGENCY</strong> <strong>DEPARTMENT</strong> ENCOUNTER <strong>FORM</strong>Category Based Emergency Department Procedure Charging GuideAcct # _______________________ MR # ________________________________Patient Name:________________________________________________________Date of Service: ______________________________________________________Office Use:Nurse: ____________________________________________________ER Clerk:__________________________________________________ 11/3/06NURSE TO CHARGE:LEVEL OF CARE 450: INFUSIONS / INJECTIONS 450: VACCINE ADMINISTRATION 450:Minimal/Fast Track0001 99281 Infusion Therapy: 0-1 Hr<strong>07</strong>65 9<strong>07</strong>65 Administration Vaccine /2104 90471Minor Care0002 99282 Infusion Ea. add’l hr. (Max 8 Hr) <strong>07</strong>66 9<strong>07</strong>66 Immunization OtherModerate Care0003 99283 Hydration: 0-1 Hr<strong>07</strong>60 9<strong>07</strong>60 Administration Ea. Add’l Vaccine 2103 90472Intermediate Care0004 99284 Hydration Ea. add’l hr.<strong>07</strong>61 9<strong>07</strong>61 Administration Hepatitis B Vaccine 0<strong>05</strong>8 90471Guarded00<strong>05</strong> 99285 Injection: Intra Arterial<strong>07</strong>73 9<strong>07</strong>73 Administration Influenza Vaccine 2100 G0008Critical Care0006 99291 Injection: Intramuscular / Subcu <strong>07</strong>72 9<strong>07</strong>72 Administration PPV Vaccine 2101 G0009Gastric Lavage/ NG Tube1500 911<strong>05</strong> Injection: IV Push Initial Drug <strong>07</strong>74 9<strong>07</strong>74 IV RELATED PROCEDURES 450:Cardioversion-Elec11<strong>05</strong> 92960 Injection: IV Push Each Add’l Seq Drug <strong>07</strong>75 9<strong>07</strong>75 Coronary Thrombolysis via IV 0040 92977Cardiopulmonary Resuscitation 0030 92950 IV Inf Add’l Seq 0-1 Hr<strong>07</strong>67 9<strong>07</strong>67 Venipuncture6415 36415Temp Transcutaneous Pacing 2953 92953 IV Infusion Concurrent<strong>07</strong>68 9<strong>07</strong>68RESPIRATORY TREATMENTIV Inf Port/Impl Pump >8 Hrs <strong>07</strong>70 C8957 OTHER _______________________________________Demo/Eval Inhal Treatment 4664 94664 POINT OF CARE TESTING 450:MISCELLANEOUSRespiratory Treatment Initial 5866 94640 Fingerstick2948 82948 Rhythm ECG w/EKG 12 Lead 3042 94664Respiratory Treatment Subsq 5868 94640 Hemoccult2270 82270Gastroccult2273 82271OTHER _______________________________________MEDICAL <strong>RECORD</strong> TO CODE:LEVEL OF CARE 450:Endo Trach Intubation1500 31500Procedural SedationTemp Transvenous Pacemaker 3210 33210Pericardiocentesis3010 33010Thoracentesis2000 32000Tube Thoracostomy2020 32020Peritoneal Asp / Lavage9080 49080Lumbar Puncture2319 62270Tracheostomy1603 31603Change of Gastrotomy Tube 3760 43760IV RELATED PROCEDURES 450:Insert PICC Line > 5 yrs 6489 36569OTHER _______________________________________INJECTION: 450:Asp / Inj Bursa Sm Joint0600 20600Asp / Inj Bursa Med Joint06<strong>05</strong> 206<strong>05</strong>Asp / Inj Bursa Lg Joint0610 20610Injection: Ligament<strong>05</strong>50 2<strong>05</strong>50Dental Block4404 64400Nerve Block4450 64450GENITAL, URINARY, RECTUMHemorrhoid / Thrombectomy 6320 46320I & D Bartholins6420 56420I & D Perianal Abscess6<strong>05</strong>0 46<strong>05</strong>0OTHER _______________________________________WOUND EXPLORATION 450:Explore Wound NeckExplore Wound ChestExplore Wound Abdm / FlankExplore Wound Extremity010001010102010320100201012010320103BURN CARE: 450:Dress/Debride - Sm w/o Anesth 6020 16020Dress/Debride - Med w/o Anesth 6025 16025Dress/Debride - Lg w/o Anesth 6030 16030OTHER _______________________________________BLOOD TRANSFUSIONS: 450:Blood Transfusion0110 36430REDUCTION OF DISLOCATIONSTMJ Dislocation1480 21480Shoulder Dislocation3650 23650Elbow Dislocation4600 24600Radial Head Subluxation4640 24640MCP Finger6700 26700Interphalangeal Joint Finger 6770 26770Patellar Dislocation7560 27560Ankle Dislocation7840 27840MCP Toe8630 28630Interphalangeal Joint Toe8660 28660INTEGUMENTARY 450:I & D Abscess0060 10060I & D Abscess - Complex0061 10061I & D Pilonidal Cyst0080 10080Incision & Removal FB, Subcu 0122 10120tissue, simpleIncision & Removal FB, Subcu 0121 10121tissue, complicatedDebridement Infected Skin 1000 11000Debridement; Skin Partial Thick 1040 11040Debridement; Skin Full Thick 1041 11041Debridement; Skin/Subcu Tissue 1042 11042Debridement; Skin/Subcu Tissue & 1043 11043MuscleINTEGUMENTARY (Cont) 450:I & D Hematoma0141 10140Puncture Asp / Abscess / Cyst / 0161 10160HematomaAvul Nail Plate, Partial / Complete 1730 11730SimpleExcision Nail Matrix1750 11750Wedge Excise, Skin of Nail Fold 1765 11765OTHER _______________________________________MISCELLANEOUS: 450:Remove Earwax9210Nasal Hemorr/Ant Pack/Caut Simp 0901Nasal Hemorr/Ant Pack/Caut Compl 0903Nasal Hemorr/Post Pack/Caut 09<strong>05</strong>Laryngoscopy15<strong>05</strong>I & D, Abscess Ear8700FRACTURE CARE: CLOSED 450:Nasal Bond1310Mandibular1450Clavicular3500Proximal Humeral3600Distal Radial5600Metacarpal, Single6600Prox / Med Phalang, Finger 6720Finger / Thumb w/o Manip 6750Radial Shaft w/o Manip5500Ulnar Shaft w/o Manip5530Patella7520Distal Tibia7760Distal Fibula7786Calcaneal8400Tarsal Bone8450Metatarsal Bone8470Great Toe8490692103090130903309<strong>05</strong>315<strong>05</strong>690002131021450235002360025600266002672026850255002553027520277602778628400284502847028490<strong>FORM</strong> <strong>322</strong>-<strong><strong>05</strong>43</strong> Rev. 5/<strong>07</strong>
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