ED Coding and Reimbursement Alert

Question: How should I report a scenario in which the emergency department physician helps an obstetrician/gynecologist in the vaginal delivery of an infant in the emergency department? What kinds of documentation should I include to strengthen this claim?

West Virginia Subscriber Answer: First, you must document medical necessity for the assistance at delivery. However, rather than reporting the delivery code and appending modifier -82 (Assistant surgeon [when qualified resident surgeon not available]), your cleanest coding option may be to report one of the ED E/M codes:

99281 - ED visit for the E/M of a patient, which requires these three key  components: a problem-focused history, a problem-focused examination, and straightforward medical decision-making
99282 - ... an expanded problem-focused history, an expanded problem- focused examination, and medical decision-making of low complexity
99283 - ... an expanded problem-focused history, an expanded problem- focused examination, and medical decision-making of moderate complexity
99284 - ... a detailed history, a detailed examination, and medical decision- making of moderate complexity
99285 - ... 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. Depending on the circumstances and the documentation provided, you could bill both an ED E/M and the appropriate delivery code. -- Reader Questions and You Be the Coder were reviewed by Michael  A. Granovsky, MD, CPC, FACEP, vice president of coding at Medical Reimbursement Systems in Stoneham, Mass.