# Help - I need to figure out these codes



## salmonsal (Jul 12, 2010)

Please help me correctly code the following scenario:

The patent presented to the emergency department complaining of vomiting coffee-ground material several times within the past 2 hours.  He has abdominal pain and has been unable to eat for the past 24 hours.  He is dizzy and light-headed.   Two stools today have been black and tarry.   While in the emergency department, he vomited bright-red blood and some coffee-ground material.  A nasogastric tube was inserted by the ED physician and attached to suction with flouro.  An abdominal exam showed a fluid wave consistent with ascites.  An IV of lactated ringers was started, and CBC and clotting studies were drawn.  A detailed history and physical exam with with-high complexity medical decision making were documented.   A GI consultant was called and the patient was taken to Endoscopy for further evaluation of upper GI bleeding.  Diagnosis:  Hematemesis, rule out esophageal varices; blood loss anemia (CBC review) acute; ascites.   CODE THE SERVICES OF THE ED PHYSICIAN.

CPT Codes:
ICD-9-CM Codes:

If anyone can help me I would greatly appreciate it.


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## jewel30956 (Jul 12, 2010)

i looks as if you have it already the hematemesis, ascites, and the anemia, i don't think you have to code the rule-out.


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## janellkangas (Jul 12, 2010)

I see that you did receive a response about coding for the diagnosis' above.  You will not code the "rule-out" because this is not a confirmed diagnosis.  
Hematemesis 578.0
Ascites 789.59

I would not code the anemia yet because even though it is listed the physician has "CBC review" so it sounds as if he knows the person is bleeding but has not confirmed the anemia with the results of the CBC.

Level of Service for Emergency Room visits need to meet or exceed in all three areas of Hx, Exam and Complexity.  He has the high complexity for the medical decision making but only he has a detailed history and detailed exam so you would be limited by these to a 99284.  If your provider thinks that he wants to code this as a level 5 then you may want to spend a little time educating him on what was missing in his history and exam documentation that would have bumped him to a comprehensive.

The insertion of the NG tube can be found in Digestive System in CPT book. 43752. This code includes fluoroscopic guidance and that will not need to be reported separately.

I hope this helps.


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