Question: Our surgeon recently treated two patients in the emergency department (ED) who were injured when their car veered off the highway. A third passenger in the vehicle was not hurt, but she was exposed to blood during the accident. The physician performed a level-two E/M service before releasing the noninjured patient. How can we prove medical necessity for the E/M service?
North Carolina Subscriber
Answer: You may use a V code as a primary diagnosis because the patient is asymptomatic.
On your claim, you should report the following:
• 99282 (Emergency department visit for the evaluation and management of a patient, which requires these three key components: an expanded problem-focused history; an expanded problem-focused examination; and medical decision-making of low complexity) for the E/M
• V15.85 (Other specified personal history presenting hazards to health; exposure to potentially hazardous body fluids) to represent the reasons for the patient’s visit
• E816.1 (Motor vehicle traffic accident due to loss of control, without collision on the highway; passenger in motor vehicle other than motorcycle) to show that the patient was in an accident
• V71.4 (Observation following other accident) to show that the physician observed the patient after an accident.
If the patient has any symptoms at all, however, you would slide V15.85 into the secondary position.
For instance, the patient who was exposed to the blood also complains of pain near her ribs during the encounter. The physician performs a level-two E/M service, checking the patient’s ribs in addition to examining her exposure to blood.
On the claim, you would submit the following:
• 99282 for the E/M
• 786.50 (Chest pain, unspecified) to represent the patient’s rib pain
• V15.85 to show that the patient was also exposed to blood
• E816.1 to indicate that the patient was in an accident
• V71.4 to note that the physician observed the patient after an accident.
