ED Coding and Reimbursement Alert

Question: A patient reports to the ED complaining of wheezing and breathlessness. The physician conducts a level-three E/M service. Suspecting emphysema, the physician conducts a spirometry with graphic record and a myleography. How should I report this encounter?

Missouri Subscriber

Answer: The answer depends on whether the physician confirms an emphysema diagnosis. The CPT codes will be the same regardless of the final diagnosis, but the ICD-9 codes will differ.

Case 1 -- Confirmed diagnosis: The physician confirms a diagnosis of emphysematous bleb. On the claim, you would report the following:

- 99283 (Emergency department visit for the evaluation and management of a patient, which requires these three key components: an expanded problem-focused history; an expanded problem-focused examination; and medical decision-making of moderate complexity) for the E/M service.

- 492.0 (Emphysematous bleb) linked to 99283 to prove medical necessity for the encounter.

Case 2 -- Inconclusive diagnosis: After the tests, the results are inconclusive or negative for emphysema. Consequently, you should rely on the signs and symptoms to support medical necessity for your physician's services. Your claim should look like this:

- 99283 for the E/M service.

- 786.05 (Shortness of breath) and 786.07 (Wheezing) linked to 99283 to prove medical necessity for the encounter.