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ED Coding and Reimbursement Alert

Reader Questions:

Roll Rabies Vaccination into E/M

Published on Wed Apr 20, 2011

Question:

A patient presents to the ED with a dog bite on his left abdominal wall, near the epigastric area. Notes indicate the injury was a puncture wound with some slight bruising, but was uncomplicated in nature. During a level-two E/M service, the physician sterilizes the wound and packs it with gauze. During the E/M, the patient reports that the dog that bit him was a stray, and it "ran off" after the attack. Due to the unknown nature of the dog's health, the physician administers a rabies vaccination. How should I code this encounter?

Minnesota Subscriber

Answer:

You'll have to roll the rabies vaccination work into the ED E/M service and report a single code for the entire encounter. On the claim, you'll likely report either 99282 (Emergency department visit for the evaluation and management of a patient, which requires these 3 key components: an expanded problem focused history; an expanded problem focused examination; and medical decision making of low complexity ...) or 99283 (...an expanded problem focused history; an expanded problem focused examination; and medical decision making of moderate complexity ...) for the E/M (make that decision based on encounter specifics.)

Also, remember to append the following diagnosis codes to the E/M code:

879.2 (Open wound of other and unspecified sites, except limbs; abdominal wall, anterior, without mention of complication) to represent the patient's wound

E906.0 (Other injury caused by animals; dog bite) to represent the cause of the patient's wound.

Explanation: Medicare will not pay ED physicians separately for rabies vaccine administration. There are some private payers that might reimburse the facility for rabies vaccinations " but there are no work units assigned to vaccinations on the professional side.

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