ED Coding and Reimbursement Alert

Question: Occasionally, we get patients in the ED that the physician decides are engaging in drug-seeking behavior some time after the initial E/M service. When this occurs, can we report an E/M code? If so, how would we choose ICD-9 codes for the encounter?

Oregon Subscriber

Answer: If the documentation indicates that the physician provided all three components of an E/M service (history, exam, medical decision making), then you could report a low-level E/M code 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 ...).

To represent the patient's drug-seeking behavior, go back and check if the notes indicate a specific drug, such  as opioids (305.5x). If there is no specific drug listed,report 305.90 (Nondependent abuse of drugs; other, mixed, or unspecified drug abuse; unspecified).

Caveat: Many physicians and medical legal experts recommend refraining from tagging patients with the "drug-seeking" label unless they are very well-known by the clinician.