ED Coding and Reimbursement Alert

Question: I have a puzzling claim in front of me. Notes indicate a patient reports to the ED after falling out of bed onto his face. He was vomiting and complaining of intense pain from a headache that he rated as 10 on a 10-point pain scale. The encounter notes indicate that the physician: "Ordered CT scan, Subluxed left front tooth pushed back into place.

"Amalgam made from dental kit, rolled to a doughy consistency then applied over the frontal teeth area splinted in a mouth-guard fashion with 2 adjacent teeth on each side.

Amalgam allowed to dry." Is this a 21085 scenario?

Kentucky Subscriber

Answer: Probably not. Even if the physician performed a 21085 (Impression and custom preparation; oral surgical splint) service, you'll have trouble getting paid for a dental code in the ED.

Best bet: Roll it into the overall ED E/M work and choose the appropriate ED E/M code. So if the notes indicate that the physician provided a level four E/M, you'd report 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 ...) for the E/M.