ED Coding and Reimbursement Alert

See if you can handle the coding when a patient handles fire  A simple accident can sometimes cause multiple complex tasks for physicians in the ED - and that difficulty transfers to the chart. Solve this case study to master multiple laceration repairs and debridement codes. Presenting complaint: Firecracker blew up in hand
 
History of present illness: A 17-year-old male who was trying to light his own firecracker, which he made with a pipe and gunpowder, had it go off in his hand about 30 minutes before arrival in the emergency department (ED), leading to injuries to that hand. He is right-handed and otherwise healthy. Up-to-date on tetanus. He also complains of pain in his right eye and thinks he may have gotten something in it. Ears are ringing. No chest or abdominal symptoms.
 
Physical exam: Alert, in pain VS reviewed
 Scalp atraumatic
 TM's intact
 Eyes: Right is red and injected. Does appear to be some particulate debris in it.
 PERRL EOMI fundi (-)
 Chest clear
 Heart RRR
 Abdomen nontender
 Extremities (-), save for right hand. There is loss of soft tissue from the tips of his index and long fingers with a little bit of exposed bone. Some first-degree burn of the adjacent tissue as well. Proximal N-V and tendon exam (-)
 
ED course of treatment:
 
Eye: Topical anesthetic placed in right eye. Multiple tiny pieces of superficial debris removed from conjunctival sac. Two foreign bodies lodged in the cornea. Fluorescein stain shows uptake only in the areas of the foreign bodies. Using slit lamp, both of these were removed with the point of a needle. Eye rinsed again and antibiotic drops instilled.
 
Hand: Digital blocks to both fingers with Marcaine. X-rays show soft tissue loss at the tips, no fractures. Hand prepped with betadine and sterilely draped. Tourniquet control employed. The exposed bone from each finger was trimmed with a bone rongeur. There was enough tissue left to debride the edges and free it up so that adequate coverage could be obtained. This was done on both fingers. Skin over tips closed with 5-0 black nylon with resulted laceration line being 1.5 cm on each finger. Tourniquet released. Dressings applied.
 
Disposition: Discussed with Dr. Hand. He will recheck in three days. Prescriptions of cephalexin and Vicodin. See Dr. Eye if eye is not better in the morning.
 How should you report this scenario? Find PMH for a Level Four  For the evaluation and management code in this case, you should report 99284 (Emergency department visit for the evaluation and management of a patient, which requires these three key components: a detailed history, a detailed examination, and medical decision making of moderate complexity), says Sharon Clement, CPC, business manager for the ED physician group at [...]