ED Coding and Reimbursement Alert

Question: At 8 a.m., a patient who had undergone a blood transfusion the previous day reports to the ED complaining of fever, nausea, and vomiting. The ED physician performs a level-two observation service. At 2 p.m. that afternoon, the ED physician discharges the patient. What ICD-9 codes should I report?

North Carolina Subscriber

Answer: Patients who develop these types of symptoms after a blood transfusion must be watched closely, as there is a possibility that the transfusion could cause bacterial contamination. The specific ICD-9 code to represent reactions to transfusions is 999.8 (Other transfusion reaction).

So on the claim, you-ll report 99235 (Observation or inpatient hospital care, for the evaluation and management of a patient including admission and discharge on the same date, which requires these three key components: a comprehensive history; a comprehensive examination; and medical decision making of moderate complexity) for the observation with 999.8 appended.

Also, remember to append 780.6 (Fever) and 787.01 (Nausea with vomiting) to 99235 to represent the patient's presenting symptoms. This diagnosis coding will be correct through Sept. 30.

Use new code after Oct. 1: Remember, when ICD-9 2009 kicks off on Oct. 1, you-ll need to include a fifth digit on all your fever diagnoses. So if you are filing the claim on or after Oct. 1, choose one of the following for the fever diagnosis:

- 780.60 -- Fever, unspecified
- 780.61 -- Fever presenting with conditions classified elsewhere
- 780.62 -- Postprocedural fever
- 780.63 -- Postvaccination fever.