ED Coding and Reimbursement Alert

Question: What level of E/M service should I report when a patient reports to the ED for treatment of a migraine headache?


Missouri Subscriber

Answer: The answer will depend on the condition of the patient when she arrives and the actions the physician performs to treat the migraine. There is no automatic E/M level for patients who report with migraines.

For example, if the patient has had frequent migraines, and reports to the ED for pain medicine or just an exam, you-d likely report either 99282 (Emergency department visit for the E/M of a patient, which requires these three key components: an expanded problem-focused history, an expanded problem-focused examination, and medical decision-making of low complexity) or 99283 (... an expanded problem-focused history, an expanded problem-focused examination, and medical decision-making of moderate complexity) for the encounter. Your code choice will be driven by medical necessity and the physician documentation.

If the migraine treatment is more involved, you-ll likely be able to report a higher-level E/M. For example, if a patient who has never had a migraine before reports for treatment with the headache in progress, the ED physician may perform a detailed history and exam, order lab tests and computed tomography scans, and prescribe pain medicine.

In this instance, you may be able to report 99284 (... a detailed history, a detailed examination, and medical decision-making of moderate complexity) for the scenario. If you report 99284 for migraine treatment, make sure the notes justify medical decision-making of moderate complexity.

E/M services for migraines occasionally warrant  99285 (Emergency department visit for the evaluation and management of a patient, which requires these three key components within the constraints imposed by the urgency of the patient's clinical condition and/or mental status: a comprehensive history; a comprehensive examination; and medical decision-making of high complexity).
 
According to CPT, you might report 99285 for treatment of a -sudden onset of the worst headache of the patient's life,- which could cause the physician to search for subarachnoid hemorrhage.