ED Coding and Reimbursement Alert

Question: A patient with frequent classical migraines presents to the ED for an exam. The ED physician develops a treatment plan for the patient and prescribes pain medication, but he orders no lab tests or computed tomography (CT) scans. Is this a level-two or level-three evaluation and management service?


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Answer: It will depend on the medical decision- making of the encounter, which you can determine through the physician's notes.

Depending on the documentation, you may report 99282 (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 low complexity) for the encounter.

But you may also be able to code the visit with 99283 (... an expanded problem-focused history, an expanded problem-focused examination, and medical decision-making of moderate complexity). You-ll have to double-check the documentation to be sure.

If you report 99282, make sure the physician has supplied documentation of an expanded problem-focused history and exam with medical decision-making of low complexity.

For 99283, you-ll likely find an expanded problem-focused history and exam with moderate-complexity medical decision-making in the documentation. The patient will likely have a chronic illness with a mild exacerbation. The treatment may include prescription-drug management. A migraine patient treated with an oral pain medication might fall into this category.

Remember: For the MDM component, two of the three categories (amount and complexity of data reviewed, number of diagnoses and management options considered, and risk) must meet or exceed the assigned MDM level for the service.

Best bet: Go back over the ED physician's notes, paying special attention to the MDM portions. This is your key to deciding the E/M level. Whether you choose 99282 or 99283, be sure to assign diagnosis code 346.00 (Classical migraine; without mention of intractable migraine) to the procedure code to represent the patient's migraine. Reader Questions and You Be the Coder reviewed by Michael A. Granovsky, MD, CPC, FACEP, vice president of Medical Reimbursement Systems Inc., an ED coding and billing company in Stoneham, Mass.