ED Coding and Reimbursement Alert

Question: A patient reports to the ED complaining of a sore throat, frequent fevers, and sore muscles. During the E/M service, the physician suspects mononucleosis and orders a heterophile screening. The patient's final diagnosis is Epstein-

Barr virus (EBV). The physician recommends the patient maintain a regimen of bed rest and acetaminophen. How should I code this scenario? Will I be able to report the screening test separately?

Florida Subscriber

Answer: You-ll be able to submit a code for the E/M, but not for the screening. Physicians can report 86308 (Heterophile antibodies; screening) only when the test occurs in the office setting. In the ED, these charges go on the hospital's facility

bill, even if the test is performed in the ED rather than in the hospital's main laboratory.

So let's say the total encounter notes paint the picture of a level-two service. On your claim, report 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 ...) with 075 (Infectious mononucleosis) appended.

Reader Questions and You Be the Coder reviewed by Michael A. Granovsky, MD, CPC, FACEP, president of MRSI, an ED coding and billing company in