ED Coding and Reimbursement Alert

Question: Our ED physician performed a limited abdominal ultrasound on a patient who complained of severe pain. The patient had surgery to remove gallstones six months prior. The ultrasound uncovered more gallstones, and the patient was admitted to the hospital for surgery to remove them. Which codes should I use to report this visit?

Indiana Subscriber

Answer: Emergency department coders should always report the appropriate signs and symptoms code as recorded by the ED physician that prompted the procedure. The patient's history of gallstone removal should be noted in the history portion of the ED E/M documentation. The examination probably uncovered that the patient had pain in the right-upper quadrant, which assisted the physician in choosing what type of study to perform. In this case, use 789.01 (Abdominal pain, right upper quadrant) and link it to 76705 (Ultrasound, abdominal, B-scan and/or real time with image documentation; limited [e.g., single organ, quadrant, follow-up]) appended with modifier -26 (Professional component).

Coders should also report the appropriate-level ED E/M code (99281-99285, Emergency department visit for the evaluation and management of a patient ), again using the presenting signs and symptoms to prove medical necessity.