I am not familiar with ED coding/billing (risk adjustment coder here) and wondering if someone can help. I received a bill for my son’s ED visit where he had a simple repair of a scalp laceration (CPT 12002). The procedure was billed twice, once for the professional component and once for the technical component. I don’t understand the rationale for billing a technical component for this procedure and am wondering if this is correct. The provider (PA) simply stapled the scalp laceration (nothing else was involved). When I look up CPT 12002 in the MPFSDB it has a value of 0 under TC/PC, which I understand means that it cannot be split into professional and technical components? An E/M code was also billed for both the technical and professional component. Also, what is the usual fee schedule for an ED? Does it make sense that the fee we are being charged for CPT 12002 is about 5x the Medicare fee? Thanks for any help.
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