ED Coding and Reimbursement Alert

Question: The ED doctor sees a child for a fracture. He performs x-rays and administers IV morphine for pain control, then discusses the patient with an orthopedist. Then, a second ED physician performs conscious sedation - which he documents separately - while waiting for the  orthopedist to reduce the fracture. All documentation meets the criteria for level four. Should we bump this to a level five at this point or leave it at level four?

Tennessee Subscriber Answer: According to CPT, in this situation, the first emergency department physician should bill for the appropriate evaluation and management service (99281-99285) and the x-ray interpretation, if he provides the required report.
 
The second ED doctor should bill the appropriate code from the anesthesia section for providing conscious sedation in support of the orthopedist's procedure.