# Professional ER Coding



## auditqueen (Jul 31, 2013)

This question is related to determining the E/M level for professional coding within the Emergency Department.  The patient presents with a suspected ankle fracture.  Physician performs all of the key elements (HPI, ROS, PFSH, Physical Exam) and orders an xray to determine whether or not the ankle is fractured.  The xray returns a negative result, the ankle is sprained not fractured.  The presenting problem was a possible ankle fracture, the final diagnosis is ankle sprain.  Ace bandage was applied and patient was sent home without any medications.  Would this be coded as a level 3 due to presenting problem of acute complicated injury, or would this be coded as a level 2 due to the final diagnsis of an acute uncomplicated illness?  Thank you.


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## Pam Brooks (Jul 31, 2013)

I'd code the level 2.  Although it's acute, it's not a complicated injury.  There was no Rx and only an ace bandage.    It doesn't meet medical necessity for anything higher.


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## ginalola77 (Jul 31, 2013)

I would code this as a two


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## jimbo1231 (Jul 31, 2013)

*99283*

I'd usually code this a 99283. That is pretty much an industry standard. Ankle sprain with problems weight bearing is cited as an example of 99283 in CPT. And the expectation is that the treatment would include a diagnostic and immobilization. But I understand that a strict reading of the Marshfield Clinic for MDM might result in coding 99282.

Jim


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## ginalola77 (Jul 31, 2013)

*Jim*

If the MD did not give an RX or read the x-ray, I would not give a three, a two.  It is a uncomplicated injury.  There was no mention of a prob with weight bearing.


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## a.montaruli@gmail.com (Aug 1, 2013)

This would be a Level 2 due to the MDM for sure. Sprains are considered an acute uncomplicated problem. Since you have no Rx given and 1 Xrays taken, you would have:

3 Points (Multiple) for New problem with no work up, 
1 Point (minimal) for the Xray
Low Risk

This is a low complexity MDM which with the HPI and Exam given is a 99282.

Hope this helps
Andrew


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## jimbo1231 (Aug 1, 2013)

*I hear you , but....*

I'm not going to try to win this argument. But I'm telling you, the ED coding/billing/staffing industry codes this a 99283. I could line up every ED coding guru you have heard of and they would all be at 99283 I understand about looking for script. But would you suggest ED docs prescribe pain killers to 10 year olds to jump to a 99284? Again, the ED guidelines are imperfect. The person shows up at an ED with a grossly swollen and painful ankle. The ED doc doesn't know this patient when they walk...or limp into the ED. Last time I'll argue this case, but I would guaruntee the ED physician who designed the CEDC would code it a 3.
But I respect you 99282s.

jim


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## jimbo1231 (Aug 1, 2013)

*And further more*

And the only reason ED docs don't prescribe pain killers in cases like these is advil works just as well. And guess what, no addiction or street value.


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## Mojo (Aug 2, 2013)

jimbo1231 said:


> I'm not going to try to win this argument. But I'm telling you, the ED coding/billing/staffing industry codes this a 99283. I could line up every ED coding guru you have heard of and they would all be at 99283 I understand about looking for script. But would you suggest ED docs prescribe pain killers to 10 year olds to jump to a 99284? Again, the ED guidelines are imperfect. The person shows up at an ED with a grossly swollen and painful ankle. The ED doc doesn't know this patient when they walk...or limp into the ED. Last time I'll argue this case, but I would guaruntee the ED physician who designed the CEDC would code it a 3.
> But I respect you 99282s.
> 
> jim



I agree. This is a low moderate on the table of risk for a minor trauma requiring a diagnostic resulting in a 99283 with supporting documentation of at least an EPF history and exam. The compliance/coding gurus note that an uncomplicated injury does not require any diagnostic work up/ancillary studies.


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## jimbo1231 (Aug 2, 2013)

*!*

Mojo,

1 supporter. Woo-hoo. Thank you , Mojo. To all of you 99282ers, I have never been able to convince anyone who believes that should be a 2 to move to 3, so I respect your position. And then there is the old 3/4 quandry. Sorry Otitis with anti-biotic doesn't get me to a 4. Oh Oh, not trying to instigate....


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## Sueedwards (Aug 2, 2013)

*Another 3*

I agree and at our facility we normally consider the sprains as a 3....


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## Mojo (Aug 2, 2013)

jimbo1231 said:


> Mojo,
> 
> 1 supporter. Woo-hoo. Thank you , Mojo. To all of you 99282ers, I have never been able to convince anyone who believes that should be a 2 to move to 3, so I respect your position. And then there is the old 3/4 quandry. Sorry Otitis with anti-biotic doesn't get me to a 4. Oh Oh, not trying to instigate....



Gosh, I hope the level twofers don't code themselves out of a job D/T lower reimbursements. Yeah, I like to stir the pot...


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