ED Coding and Reimbursement Alert

Question: A female patient with a history of menstrual migraines presents with an onset of neurological symptoms indicating another migraine; she rates the pain a 9 on a 10-point scale. After attempting to stop the migraine with oral pain medication, the physician injects the patient with 6 mg of Imitrex and 1 unit of Compazine. Notes indicate a level-four E/M service. I reported 96372 x 2 and received a denial. I don't get it; we've gotten paid for patients that the physician treats with trigger point injections (TPIs) in the past: how is this different?New York SubscriberAnswer: Your scenario is not a TPI, but a subcutaneous injection of two drugs to control a patient's migraine. On the claim, you'll have to choose the appropriate ED E/M code for the entire  encounter.Most likely, you'll report 99284 (Emergency department visit for the evaluation and management of a patient, which requires these 3 key [...]