ED Coding and Reimbursement Alert

Question: Can I report alcohol cessation counseling codes along with ED E/M codes, or do I have to choose one or the other?

Idaho Subscriber

Answer: You can, and in most cases will, report counseling codes along with E/M services. The behavior change intervention codes are intended to be reported in addition to an E/M service when the provider furnishes them. Most counseling sessions in the ED occur after the provider performs some sort of E/M. Consider this case study:

A patient presents to the ED with a large bruise on his forehead. He says he fell off the curb while walking. The patient's skin is a splotchy yellow, and he reports experiencing generalized fatigue "for as long as I can remember." Due to the smell of alcohol and the patient's symptoms, the physician asks the patient if he has been drinking. The patient says, "Yes", so the physician decides to conduct the CAGE test to gauge alcohol abuse (www.counsellingresource.com/quizzes/alcohol-cage/index.html).

Based on the test results, the physician determines that the patient is at least moderately dependent on alcohol; she performs extensive counseling and recommends the patient start attending Alcoholics Anonymous or some other community support group for alcohol-addicted individuals. The physician then finishes her patient exam, and recommends ice and ibuprofen for the head injury.

She also recommends that the patient schedule a visit with a gastroenterologist for a cirrhosis screening. The alcohol counseling lasted 18 minutes, and notes indicate the physician also performed a level-two ED E/M.

In this instance, the ED physician performs both an E/M service and alcohol counseling.

On the claim, you would report the following:

• 99282 (Emergency department visit for the evaluation and management of a patient, which requires these 3 key components ...) for the E/M

• modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) appended to 99282 to show that the E/M was a separate service from the counseling

• 782.4 (Jaundice, unspecified, not of newborn) appended to 99282 to represent the skin condition

• 780.79 (Other malaise and fatigue) appended to 99282 to represent the patient's fatigue

• 920 (Contusion of face, scalp, and neck except eye[s]) appended to 99282 to represent the patient's head injury

• E880.1 (Fall on or from sidewalk curb) appended to 99282 to represent the cause of the patient's injury

• 99408 (Alcohol and/or substance [other than tobacco] abuse structured screening [e.g., AUDIT, DAST], and brief intervention [SBI] services; 15 to 30 minutes) for the counseling service

• 305.00 (Alcohol abuse, unspecified) appended to 99408 to represent the patient's alcohol dependence.