ED Coding and Reimbursement Alert

Question: Our ED physicians do a lot of their own  x-ray interpretations. If they interpret a chest x-ray and an EKG, we charge for the interpretation with modifier    -26 (Professional component). Usually, we only charge for one interpretation and include the other in the E/M work. Is it possible to charge for both and still use the points toward E/M?

Connecticut Subscriber Answer: Technically, the ordering of an x-ray or electrocardiogram (EKG), interpreting the study results, and applying those results to the patient's clinical condition all require separate cognitive work by the physician. In fact, many radiologists actually sign reports with the documentation "clinical correlation required," because they just read the film.
 
In theory, you could get one evaluation and management point for ordering an x-ray, one point for ordering an EKG, and two points if the physician interpreted either independently. Many experts would then allow a total of four points if the doctor ordered both an EKG and x-ray and reads one independently. In that case, you would report one of the following E/M codes:

99281 - Emergency department visit for the evaluation and management 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 - ... a comprehensive history, a comprehensive examination, and medical decision-making   of high complexity. Best bet: You may find lack of consistency on this issue among different carriers, so checking with individual carriers may be wise.