ED Coding and Reimbursement Alert

Question:A 45-year-old male patient reports to the ED with chest pain and mild shortness of breath; the physician's initial clinical judgment is a possible cardiac etiology , so he performs a comprehensive history and exam, as well as ordering labs, a two view chest x-ray, and an electrocardiogram (EKG). The workup reveals no cardiac condition, but rather severe indigestion. The physician orders a GI "cocktail" and sends the patient home. How should I code this encounter?Washington, DC SubscriberAnswer:Since the nature of the presenting problem (NOPP) was so high for this patient (possible heart attack), this is likely a high-complexity medical decision making encounter.Go back and check the notes to ensure that the MDM was high-level. If that is the case, report the following:99285 (Emergency department visit for the evaluation and management of a patient, which requires these 3 key components imposed by the urgency of the patient's clinical condition and/or [...]