ED Coding and Reimbursement Alert

Question: A patient presents to the ED complaining of a headache that has gotten progressively worse over the past four days. She complains of blurred vision and vomiting with nausea. Notes indicate that the patient has had four of these types of headaches in the past two weeks. The system review included a detailed neurological examination and a general system exam to address the patient's presenting condition. After assessment and discussion with the patient, the physician diagnoses "migraine w/ aura and Blurred vision NOS" and provides the patient with prescription medication. Notes indicate a levelfour ED E/M service. How should I order the diagnosis codes for this encounter?Idaho SubscriberAnswer: The blurred vision is a clue that this is a migraine with aura; this should be the first diagnosis code you list. On the claim, report the following: 99284 (Emergency department visit for the evaluation and management of a patient, which requires [...]