ED Coding and Reimbursement Alert

Question: The ED physician is called to see a hospital inpatient with emphysema who is having trouble breathing, and complaining of a hacking cough. Notes indicate that the physician performed a problem focused history, an expanded problem focused examination, and moderately complex medical decision making. I coded 99282 and received a denial. What did I do wrong?

Minnesota Subscriber

Answer: You chose from the wrong code set; 99282 (Emergency department visit for the evaluation and management of a patient &) is for ED services, but since the physician was treating a hospital inpatient, you should have chosen from the subsequent hospital care codes instead.

When you resubmit the claim, report 99232 (Subsequent hospital care, per day, for the evaluation and management of a patient, which requires at least 2 of these 3 key components: an expanded problem focused interval history; an expanded problem focused examination; medical decision making of moderate complexity).

Remember, with subsequent hospital care codes, you only need to satisfy two of the three component requirements in the code descriptor (history, exam, MDM). With ED E/M codes 99281-99285, the physician must fulfill all three in order to report a particular level.