ED Coding and Reimbursement Alert

Question: A mother brought her child to our ED because her 8-month-old daughter was "acting sick" by screaming constantly. The only symptoms the physician charted were runny nose and  constant screaming crying and fussiness. Notes indicate a level-one E/M service. The physician told me to code the diagnosis as "worried well check," but I'm not sure. What's the best option?

Texas Subscriber

Answer: The diagnosis code you should use in addition to 99281 (Emergency department visit for the evaluation and management of a patient, which requires these 3 key components: a problem focused history; a problem focused  examination; and straightforward medical decision making ...)  should reflect the patient's documented symptoms.

Your physician's undocumented comment won't suffice for the claim. You normally report V65.5 (Person with feared complaint in whom no diagnosis was made) when a patient doesn't have a problem but wants to be checked and reassured.

You have other symptoms that would serve as better diagnoses. Appropriate symptoms in this situation could include 784.91 (Symptoms involving head and neck; post nasal drip) for the runny nose 780.91 (General symptoms; other general symptoms; fussy infant [baby]) for the fussiness 780.92 (... excessive crying of infant [baby]) for the crying and screaming.

Best bet: Double-check with the physician to see if you've chosen the best diagnosis codes to reflect the infant's symptoms.