ED Coding and Reimbursement Alert

From gastritis to conjunctivitis: These are the right diagnosis codes to use.

Flu season is coming to a close, winter weather is almost behind us, and summer injuries are on the horizon. Therefore, your ED could be seeing a wide variety of illnesses and injuries that span the seasons. Check out the following FAQs, along with answers, to determine how to code these conditions commonly seen in the ED.

Can You Code Acute Respiratory Distress Syndrome?

A 64-year-old female patient presents with complaints of severe dyspnea and agitation. The physician performs a comprehensive history and examines the patient. During examination, the patient appears to be in a state of anxiety. The doctor notes the presence of cyanosis and tachycardia. Upon auscultation, he notes fine bilateral rales.

The physician suspects acute respiratory distress syndrome and sends an arterial blood sample to the lab for analysis of blood gases. He also orders a chest x-ray and echocardiography, as well as CBC, kidney, and liver function tests. The lab results indicate that the fluid is positive for increased eosinophil counts. Based on the history, signs and symptoms, physical examination, and lab results, the doctor arrives at a diagnosis of acute respiratory distress syndrome.

Solution: In this case, you should report the codes for the signs and symptoms (e.g., R06.00,  Dyspnea, unspecified), R23.0 (Cyanosis) or R00.0 (Tachycardia, unspecified) to order the testing. You'll report the evaluation with the diagnosis code for acute respiratory distress syndrome using J80 (Acute respiratory distress syndrome).

Check This Gastritis Scenario

The physician assesses a 58-year-old male patient who has been suffering from frequent episodes of abdominal pain and bloating for several months, but says that today the pain is unbearable. Upon examination, your physician notes the presence of epigastric tenderness. Testing confirms gastritis with bleeding due to H. pylori.

Solution: You will report K29.41 (Chronic atrophic gastritis with bleeding), or depending on how the pathologic findings are read, K29.31 (Chronic superficial gastritis with bleeding). Since the cause (H pylori) is known, a second diagnosis B96.81 (Helicobacter pylori [H. pylori] as the cause of diseases classified elsewhere) is also applicable.

Nail Down Tachycardia Diagnosis

The physician treats a patient suffering from a rapid heart rate. The ED physician runs tests and diagnoses the patient with paroxysmal supraventricular tachycardia.

Solution: The correct ICD-10 code in this case is I47.1 (Supraventricular tachycardia). Included conditions for I47.1 are as follows:

• Atrial (paroxysmal) tachycardia
• Atrioventricular [AV] (paroxysmal) tachycardia
• Atrioventricular re-entrant (nodal) tachycardia [AVNRT] [AVRT]
• Junctional (paroxysmal) tachycardia
• Nodal (paroxysmal) tachycardia.

Don't miss: A code first note instructs you to sequence tachycardia complicating the following conditions first, followed by I47.1:

• O00.0 (Abdominal pregnancy) through O07 (Failed attempted termination of pregnancy)
• O08 (Complications following ectopic and molar pregnancy)
• O75.4 (Other complications of obstetric surgery and procedures).

Therefore, if you diagnose this condition in a patient that has one of the above three diagnoses, report that ICD-10 code first.

Pinpoint Blepharoconjunctivitis Dx

A 57-year-old male patient presents with an itchy, red, swollen left eye, which he reports has been so productive that it is sealed shut when he wakes up in the morning. On taking a history and performing an examination, the ED clinician notes »» that the patient has scaly, dry skin on his upper and lower left eyelids, and that his tear production is extremely low. He diagnoses the patient with blepharoconjunctivitis and prescribes an antibiotic ointment. Which diagnosis code should you report for this encounter?

Solution: Because the physician didn't specify a type of blepharoconjunctivitis (such as angular, ligneous or contact), you should report the code for the unspecified condition. Because the patient's left eye was affected, you'll report H10.502 (Unspecified blepharoconjunctivitis, left eye). You don't need to report a separate code to denote that both the upper and lower eyelids were affected, since this code is appropriate to cover the entire condition.