ED Coding and Reimbursement Alert

Answer: Hopefully, you’ll be able to get a little more information before having to choose a diagnosis code to go with your 99284 (Emergency department visit for the evaluation and management of a patient, which requires these 3 key components: A detailed history; A detailed examination; and Medical decision making of moderate complexity...) E/M code.

Do this: Go back and check the notes to see if there is any indication as to the specific location in the right humerus where the subluxation occurred. Then, choose from one of the following codes:

• S43.011A (Anterior subluxation of right humerus, initial encounter)
• S43.021A (Posterior subluxation of right humerus, initial encounter)
• S43.031A (Inferior subluxation of right humerus, initial encounter)
• S43.081A (Other subluxation of right shoulder joint, initial encounter)

Last resort: If you cannot get the location of the injury within the humerus, then choose S43.001A (Unspecified subluxation of right shoulder joint, initial encounter) to append to your 99284 claim.