ED Coding and Reimbursement Alert

Question: A patient reports to the ED complaining of pain that started in his chest and spread left toward his shoulder and arm. He says that this is the third episode he's had in the past week. Also, the patient says the pain seems to occur after he exercises. During the course of a level-four E/M, the ED physician diagnoses angina pectoris. But exactly what type of angina did this patient suffer from? Michigan Subscriber Answer: There are several types of angina; judging from the description, this patient may have had stable angina, which is marked by recurrent episodes of unspecified chest pain. The ICD-9 code for stable angina is 413.9 (Other and unspecified angina pectoris). Check the notes to make sure the angina did not advance to a more serious condition, such as cardiac arrest. If it didn-t, you should report the following: - 99284 (Emergency department visit for the evaluation and management of a patient, which requires these three key components: a detailed history; a detailed examination; and medical decision-making of moderate complexity) for the E/M - 413.9 appended to 99284 to represent the angina.