ED Coding and Reimbursement Alert

Question: A patient with osteoporosis reports to the ED complaining of wrist pain. The physician inspects the patient's wrist, diagnoses bursitis, and performs an arthrocentesis injection with 40 mg of Sano-Drol. Can I report a separate E/M in this scenario?

Alabama Subscriber

Answer: Yes, you can report an E/M. Since patients do not report to the ED for scheduled procedures, the work the physician performs pre-procedure is almost always a separate E/M. In your scenario, the work the physician performs diagnosing the bursitis is considered a separate E/M.

On the claim, report the following:

- 20605 (Arthrocentesis, aspiration and/or injection;intermediate joint or bursa [e.g., temporomandibular,acromioclavicular, wrist, elbow or ankle, olecranon bursa]) for the arthrocentesis

- the appropriate level E/M code based on the encounter notes, such as 99282 (Emergency department visit for the evaluation and management of a patient,which requires these 3 key components: an expanded problem focused history; an expanded problem focused examination; and medical decision making of low complexity)

- modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) appended to the E/M code to show that the E/M and the injection were separate services

- 726.4 (Enthesopathy of wrist and carpus) appended to 20605 and the E/M code to represent the patient's bursitis

- 733.00 (Osteoporosis, unspecified) appended to 20605 and the E/M code to represent the patient's osteoporosis.