ED Coding and Reimbursement Alert

Question: Are there any guidelines explaining what effect discharge has on billing for 99285? We have quite a few patients who are discharged and coded this way, usually after an evaluation for chest or abdominal pain. There are some scenarios in which the symptoms are obvious (septic workup in a dehydrated child who has intravenous [IV] hydration, meds, labs, coordination of care).

Arizona Subscriber

Answer: Experts agree that patients who present with chest pain that is suggestive of a serious condition get a full evaluation for possible myocardial infraction (MI) or pulmonary embolus. If they are ultimately found not to have either condition, you should code 99285 (emergency department visit for the evaluation and management of a patient) if the documentation supports it (i.e., comprehensive history, comprehensive evaluation, and medical decision-making of high complexity).

Presenting problem and medical decision-making are the critical factors, not the ultimate disposition. Whether a patient has been discharged is not a factor in the level of the visit. To bill for 99285, the documentation must support the level.