ED Coding and Reimbursement Alert

Question: A 68-year-old Medicare patient reports to the ED in cardiac distress. The physician performs CPR and then stabilizes the patient during a level-five E/M service; he diagnoses a diaphragmatic acute myocardial infarction (AMI). Notes indicate that the physician did not give the patient aspirin due to an allergy. Can we still report this encounter under the physician quality reporting initiative (PQRI)?

New York Subscriber

Answer: This visit meets the requirements for PQRI measure 28: -Aspirin at Arrival for Acute Myocardial Infarction (AMI).- You will, however, need to remember a P modifier to explain why the physician did not give the patient aspirin.

On the claim, report the following:

- 99285 (Emergency department visit for the evaluation and management of a patient, which requires these 3 key components within the constraints imposed by the urgency of the patient's clinical condition and/or mental status: a comprehensive history; a comprehensive examination; and medical decision making of high complexity ...) for the E/M

- modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) appended to 99285 to show that the E/M and CPR were separate services

- 92950 (Cardiopulmonary resuscitation [e.g., in cardiac arrest]) for the CPR

- 4084F (Aspirin received within 24 hours before emergency department arrival or during emergency department stay [E/M]) to represent the PQRI measure

- modifier 1P (Measure not met for medical reasons) appended to 4084F to show that the measure was not met because of the patient's allergy to aspirin

- 410.41 (Acute myocardial infarction of other inferior wall; initial episode of care) appended to 99285, 92950, and 4084F to represent the patient's AMI.