ED Coding and Reimbursement Alert

Question: A driver who was in a motor vehicle collision (MVC) arrives at the ED via ambulance with blunt trauma to his chest and abdomen from the seat belt and airbag; the patient is complaining of pain in his chest and severe abdominal pain due to the contusions. The physician performs a comprehensive history and examination and high complexity medical decision making. She then performs a focused assessment with sonography in trauma (FAST) exam and an electrocardiogram (ECG). Final diagnosis is "Contusions, chest/trunk." All of these services occurred on the same calendar date. What is the proper coding for this scenario?

Montana Subscriber

Answer: To keep this from getting too confusing, we'll list the procedure codes for this claim, and then list the ICD-9 codes separately. For this claim, you'll want to report the following CPT® codes:

• 93308 (Echocardiography, transthoracic, real-time with image documentation [2D] includes M-mode recording, when performed, follow-up or limited study) for the first portion of the FAST exam  
• 76705 (Ultrasound, abdominal, real-time with image documentation; limited [e.g., single organ, quadrant, follow-up]) for the second portion of the FAST exam
• 93010 (Electrocardiogram, routine ECG with at least 12 leads; interpretation and report only) for the ECG

Modifier 26 (Professional component) appended to 93308 and 76705 to show you are only coding for the physician's interpretation of the ultrasounds

• 99285 (Emergency department visit for the evaluation and management of a patient, which requires these 3 key components within the constraints imposed by the urgency of the patient's clinical condition and/or mental status: a comprehensive history; a comprehensive examination; and medical decision making of high complexity ...) for the E/M service

Modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) appended to 99285 to show that the E/M was separate from the other services For this claim, you'll want to report the following ICD-9 codes:

• 786.52 (Chest pain; painful respiration) appended to 99285 to represent the patient's chest pain
• 789.09 (Other symptoms involving abdomen and pelvis; abdominal pain; other specified site) appended to 99285 to represent the patient's abdominal pain
• 922.1 (Contusion of trunk; chest wall) appended to 93308, 76705 and 93010 to represent the patient's chest contusions
• 922.2 (... abdominal wall) appended to 93308, 76705 and 93010 to represent the patient's abdominal contusions.