ED Coding and Reimbursement Alert

Question: A patient reports to the ED complaining of tightness in his chest and heart palpitations. The ED physician performs a carotid massage on the patient. How should I report the massage? Is there a CPT code for it?

Ohio Subscriber

Answer: There is no CPT code to represent carotid massage. However, you can roll the work from the massage into the overall E/M code level.

Suppose that notes for the entire encounter indicate a level-four E/M. On the claim, report the following:

- 99284 (Emergency department visit for the evaluation and management of a patient, which requires these three key components: a detailed history; a detailed examination; and medical decision-making of moderate complexity) for the E/M

- 785.1 (Symptoms involving cardiovascular system; palpitations) linked to 99284 to represent the patient's palpitations

- 786.50 (Chest pain, unspecified) linked to 99284 to represent the patient's chest pain.