ED Coding and Reimbursement Alert

Question: A patient comes into the ED suffering a panic attack, with complaints of chest pain and wheezing. Do I need to choose one of these symptoms as the chief complaint, or can you have multiple chief complaints?

Idaho Subscriber

Answer: Chief complaint is typically defined as a concise statement in the notes that describes the patient’s problem, condition, diagnosis, or other factor that is the reason for the visit. This can be one or more symptoms that prompt the patient’s ED presentation, and can include:

• illness
• injury
• psychiatric conditions
• normal bodily process that the patient perceives as abnormal
• patient’s perception of the problem.

All of the patient’s presenting problems qualify as chief complaints, so you should list panic attack (300.01, Panic disorder without agoraphobia), chest pain (786.50, Chest pain, unspecified), wheezing (786.07, Dyspnea and respiratory abnormalities; wheezing), and as the reason for the visit.

Remember: Chief complaint is best gleaned from the patient’s own words, so scour the notes for direct quotes from the patient, such as “I’m really nervous about the chest pain and wheezing I’m having.” It is often found in the HPI section of the history documentation if there is not a separate template spot for listing chief complaint.