ED Coding and Reimbursement Alert

Question: A mother brings her 6-year-old son into the ED on a Saturday afternoon; she reports that the child has been screaming for almost nine hours due to pain in his right ear. During a level-three E/M, the physician diagnoses otitis media. Can I just code for the final diagnosis, or should I include ear pain as well?

Massachusetts Subscriber

Answer: You might want to include an ear pain diagnosis, just to be safe. Without the ear pain diagnosis, some insurers could question whether the child required emergency care in this situation.

On the claim, report the following:

- 99283 (Emergency department visit for the evalua-tion 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 moderate complexity ...) for the E/M

- 382.9 (Unspecified otitis media) appended to 99283 to represent the final diagnosis

- 388.70 (Otalgia, unspecified) appended to 99283 to represent the presenting symptom.