ED Coding and Reimbursement Alert

Question: A patient presents to the emergency department (ED) complaining of diarrhea, nausea and vomiting, dehydration, and abdominal cramping for the past 24 hours. The ED physician orders tests and rehydration of the patient during an ED evaluation and management (E/M) service. Final diagnosis was echovirus enteritis. How many ICD-10-CM codes should I submit for this patient?

Wisconsin Subscriber

Answer: You’ll need only a single code for this patient: A08.39 (Other vital enteritis). ICD-10-CM instructs coders to report A08.39 when the physician lists echovirus enteritis as the final diagnosis. Other types of enteritis you should report with A08.39 are coxsackie virus enteritis, enterovirus enteritis NEC, and torovirus enteritis.

Be sure to include only this diagnosis code when you report your ED E/M code: 99281 (Emergency department visit for the evaluation and management of a patient that may not require the presence of a physician or other qualified health care professional) through 99285 (Emergency department visit for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and high level of medical decision making), depending on encounter specifics.

So why only a single diagnosis code even though the patient exhibited so many symptoms? It’s because the physician reached a definitive diagnosis of echovirus enteritis. When the physician reaches a definitive diagnosis, you shouldn’t code for the patient’s presenting symptoms.

Exception: Let’s say the same patient reports to the ED, but the physician does not reach a definitive diagnosis. In that case, you would report ICD-10-CM codes for all of their presenting symptoms: diarrhea, nausea and vomiting, dehydration, and abdominal cramping.

Chris Boucher, MS, CPC, Senior Development Editor, AAPC