ED Coding and Reimbursement Alert

Question: A patient comes into the ED suffering a panic attack, with complaints of chest pain and wheezing. Do I need to choose one of these symptoms to list as the chief complaint, or can you have multiple CCs?

Idaho Subscriber

Answer: CC is typically defined as a concise statement in the notes that describes the patient's problem, condition, diagnosis, or other factor that is the reason for the visit. This can be one or more symptoms that prompt the patient's ED presentation, and can include:

• illness

• injury

• psychiatric conditions

• normal bodily process that the patient perceives as abnormal

• patient's perception of the problem.

All the patient's presenting problems qualify as CCs, so you should list panic attack (300.01, Panic disorder without agoraphobia), chest pain (786.50, Chest pain, unspecified), and wheezing (786.07, Dyspnea and respiratory abnormalities; wheezing), as the reasons for the visit. CC is best gleaned from the patient's own words, so scour the notes for direct quotes from the patient, such as "I'm very nervous about my chest pain and wheezing."