ED Coding and Reimbursement Alert

Answer: Your physician’s treatment of the patient’s ribs isn’t separately reportable You can, however, consider the treatment when deciding on the overall level of the evaluation and management (E/M) service. In addition to the physical and exam, you should factor the X-ray order/interpretation and the physician’s advice to the patient when deciding on an E/M code.

E/M level: The type and severity of the injury are indicative of an acute complicated injury indicating a moderate complexity of problems addressed (COPA). The order for the X-ray is one Category 1 point for ordering of each unique test; if documented, the ED physician’s independent interpretation of the X-ray would count in Category 2 for independent interpretation of a test. These elements would support moderate data. The prescription for NSAIDs would support moderate risk for prescription drug management.

Moderate COPA, moderate data, and moderate risk combine to support a level-four ED E/M service.

On the claim, you should report:

• 99284 (Emergency department visit for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and moderate level medical decision making) for the E/M
• S20.219A (Contusion of unspecified front wall of thorax, initial encounter) appended to 99284 to represent the patient’s rib bruises
• S20.01XA (Contusion of right breast, initial encounter) appended to 99284 to represent the patient’s chest bruise
• W13.0XXA (Fall from, out of or through balcony, initial encounter) appended to 99284 to represent the cause of the patient’s injuries.