ED Coding and Reimbursement Alert

Question: A patient who had apparently attempted suicide by ingesting multiple medications presented to the emergency department. Which code should I report, and are there E codes for this situation?

Kentucky Subscriber
 
Answer: In this case, you should report the appropriate ED E/M code (99281-99285) and add to that any separately billable procedures your ED physician performed, such as 91105 (Gastric intubation, and aspiration or lavage for treatment [e.g., for ingested poisons]).

You will also need to report an E code to describe the suicide attempt. See the E950.x series (Suicide and self-inflicted poisoning by solid or liquid substances).

But these cases may not always be straightforward. For example, a patient comes to the ED after taking 15 Paxil, nine Ativan, and ingesting six or seven cocktails in an attempt to kill herself. She is lethargic, has low blood pressure, and isn't breathing steadily.

The ED doctor performs a stomach lavage and orders an electrcardiogram because the patient is having difficulty breathing. The physician reads the EKG and performs a complete history and physical exam. Because the patient is too lethargic to participate, the doctor speaks to the family and asks them to rummage through the patient's belongings to find the pill bottles.

For this patient, you'd report 91105 for the stomach lavage, and 93010 (Electrocardiogram ...; interpretation and report only) for the EKG interpretation (if they are well-documented). In addition, you should report the appropriate ED E/M code. You should report the poisoning with these five codes:

969.0 - Poisoning; antidepressants

969.4 - Poisoning; benzodiazepine

980.0 - Toxic effect; ethyl alcohol

E950.4 - Suicide and self-inflicted poisoning by solid or liquid substances; other specified drugs and medicinal substances

E950.9 - ... other and unspecified solid and liquid substances.