ED Coding and Reimbursement Alert

Question: A father brings his 2-year-old son into the ED with an injury to his right ear; the boy was scratching at the ear, which appeared swollen and red. The ED physician performs a level-two E/M, during which she visualizes a foreign body (FB) in the external ear. The physician then performs irrigation to flush out the object and ultimately is able to grab it with alligator forceps under magnification (no mention of anesthesia in notes). The FB was a piece of gravel from a fish tank. Can I code the procedure separately, or is it considered part of the E/M?

Massachusetts Subscriber

Answer: Based on your description, you should be able to report an E/M and a procedure code for this scenario. On the claim, report the following:

" 69200 (Removal foreign body from external auditory canal; without general anesthesia) for the FB removal

" 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) 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 the E/M and FB removal were separate services

" 931 (Foreign body in ear) appended to 69200 and 99282 to represent the FB.

-- 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 Woburn, Mass.