ED Coding and Reimbursement Alert

Because no anthrax screening codes currently exist, ED physicians and coders face a quandary about how to report cases of possible anthrax exposure. Emergency rooms have begun to see more patients requesting
evaluation when they receive or are exposed to envelopes carrying unidentified white powder. Under these circumstances, coders should assign codes describing the symptoms being assessed, along with an ED visit code that reflects the level of service provided.
 
Medicare issued a memorandum late in October noting that it would cover screening or diagnostic tests for anthrax, even in the absence of symptoms, if reasons for the assessment are documented. A written order from a physician is required.
 
Note: Once a diagnosis of anthrax is confirmed, it would be reported with a code from the 022.0-022.9 series. However, the culture for anthrax takes two days to complete, requiring an ED physician to report only the symptoms that prompted the visit.
 
Sharon R. Foster, CPC, clinical reimbursement manager for the Stamford Hospital Emergency Department in Stamford, Conn., says she coded three such
screening cases in one day during the third week of anthrax cases being reported nationwide. Were just across the New York state line and several patients came in with suspected exposure. Two of these were exhibiting symptoms, she noted, while the other was screened for possible exposure.
 
The two patients presented with symptoms of cough and cold, and we reported those relevant diagnosis codes (e.g., 786.2, cough), she says. In addition, we used the V-code for observation of a suspected condition [V71.89, observation for other specified suspected conditions]. Her department reported a low-level E/M code for the visit (e.g. 99282, emergency department visit [expanded problem-focused history and exam, with medical decision making of low complexity]). Other coding experts say they would anticipate a higher level E/M code to be assigned because exposure to anthrax is considered potentially life-threatening and the patient is therefore at high risk. Ultimately, the level of service reported should reflect the work performed and documented.
 
Coding the screening evaluation for the patient exhibiting no symptoms was somewhat different, Foster says. This particular individual was in the building when an envelope was opened, but was not symptomatic. In that case, V71.89 was assigned, along with V74.8 (special screening examination for bacterial and spirochetal diseases; other specified bacterial and spirochetal diseases).
 
Medicare announced that if the patient has confirmed contact with the biological agent, V01.8 (contact with or exposure to communicable diseases) would be reported. Additionally, claims submitted for patients with positive nasal swab results would be coded 795.3 (nonspecific positive culture findings). If these patients are prescribed antiobiotics, V07.39 (other prophylactic chemotherapy) is appropriate.
 
I imagine that an anthrax screening code will surface over the course of the next year, as these cases continue to be a factor, Foster says.