ED Coding and Reimbursement Alert

Question: How should I submit a charge for the physician's death pronouncement (or death note)?


Kentucky Subscriber

Answer: No specific code for death pronouncement exists. If the doctor issued the pronouncement in the context of an emergency department evaluation, you should report the appropriate ED evaluation and management code from among the following:

- 99281--Emergency department visit for the evaluation and management of a patient, which requires these three key components: a problem-focused history, a problem-focused examination, and   straightforward medical decision-making

- 99282---an expanded problem-focused history, an expanded problem-focused examination, and medical decision-making of low complexity

- 99283---an expanded problem-focused history, an expanded problem-focused examination, and medical decision-making of moderate complexity

- 99284---a detailed history, a detailed examination, and medical decision-making of moderate complexity

- 99285--Emergency department evaluation and management of a patient, which requires these three key components within the constraints imposed by the urgency of the patient's clinical condition and/or mental status: a comprehensive history, a comprehensive examination, and medical decision-making of high complexity.

If the physician pronounced the patient for a floor response, a subsequent hospital care visit code may apply.

For all of these E/M codes, the physician must document the appropriate history and physical exam. It would be difficult to obtain much of a history from a dead patient. If the situation were such that the hospital needed the physician simply to -go and pronounce,- most ED groups provide this service as a courtesy and do not bill for it.