ED Coding and Reimbursement Alert
Mother's Milk Making Baby Sick? Check Drug Reaction Codes
Question: A mother who is taking Flexeril brings her 1-month-old child into the ED. The patient breast-feeds the child, and the mother is concerned about the drug affecting her baby, who is sleepy, easily aroused and cries easily. The physician performs a level-two E/M service and sends them home. What diagnosis code should I use for this patient?
New Mexico Subscriber
Answer: You should probably check the encounter notes to see if the physician indicates the baby was having a Flexeril reaction. If so, report 99282 (Emergency department visit for the evaluation and management of a patient, which requires these three key components: an expanded problem-focused history; an expanded problem-focused examination; and medical decision-making of low complexity) for the E/M, with 779.4 (Drug reactions and intoxications specific to newborn) linked to 99282 to represent the patient's condition.
If the notes do not indicate a Flexeril reaction, report 99282 with 780.91 (Fussy infant [baby]) to represent the patient's condition.
ED Coding and Reimbursement Alert
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