ED Coding and Reimbursement Alert

Question: Our ED physician treated a patient with a pressure ulcer on the back of her head. After performing a level-two evaluation and management service, the physician diagnosed the ulcer, then performed partial- thickness debridement on the wound. How should I report this encounter?

Mississippi Subscriber

 Answer: You-ll be able to code for an E/M and a debridement in this instance:

 - report 11040 (Debridement; skin, partial thickness) for the debridement.
 - attach 707.09 (Decubitus ulcer; other site) to 11040 to represent the patient's ulcer.
 - report 99282 (Emergency department visit for the evaluation and management of a patient, which requires these three key components: an expanded problem- focused history; an expanded problem-focused examination; and medical decision-making of low complexity) for the E/M service.
 - attach 707.09 to 99282 to represent the patient's ulcer.
 - link modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) to 99282 to show that the E/M was separate service from the debridement.

Remember: In this scenario, you can use 707.09 as the diagnosis for both CPT codes. If the physician performs an E/M and a procedure for the same problem, you can report the same diagnosis code for both. Regarding this type of scenario CPT states, -different diagnoses are not required for the reporting of the procedure and the E/M service on the same date.- Although correct by CPT standards, be aware that some payers may have reimbursement edits that look for a second diagnosis.