ED Coding and Reimbursement Alert

Question: A patient complaining of chest pain reported to the ED. The physician performed critical care services for 32 minutes and diagnosed acute myocardial infarction. She then performed an intubation and coronary thrombolysis via intravenous delivery. How should I code this encounter?


Mississippi Subscriber

Answer: You-ll use three CPT codes and a pair of ICD-9 codes for this scenario.

On the claim,

- report 92977 (Thrombolysis, coronary; by intravenous infusion) for the thrombolysis.

- report 31500 (Intubation, endotracheal, emergency procedure) for the intubation.

- attach 410.01 (Acute myocardial infarction; of anterolateral wall; initial episode of care) to 92977 and 31500 to represent the patient's myocardial infarction.

- report 99291 (Critical care, evaluation and management of the critically ill or critically injured patient; first 30-74 minutes) for the E/M service.

- attach 786.50 (Chest pain, unspecified) to 99291 to represent the patient's chest pain. (If the physician makes the formal diagnosis of acute MI, you should look to the 410.x code set.)

- append modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) to 99291 to show that the E/M was separate from the other procedures.