ED Coding and Reimbursement Alert

Question: Our ED recently treated two patients that sustained injuries when their car veered off the highway. There was also a third passenger in the vehicle that was not hurt, but she was exposed to blood during the accident. The physician performed a level 2 evaluation and management (E/M) service before releasing the non-injured patient. How can we prove medical necessity for the E/M service?

North Carolina Subscriber

Answer: You  may use a V code as a primary diagnosis since the patient is asymptomatic.

On your claim,:

- report 99282 ( Emergency department visit for the evaluation and management of a patient, which requires these three key components: an expanded problem focused history; an expanded problem focused examination; and medical decision making of low complexity) for the E/M.

- attach ICD-9 code V15.85 (Other specified personal history presenting hazards to health; exposure to potentially hazardous body fluids) to 99282  to represent the reasons for the patient's visit.

- attach ICD-9 code E816.1 (Motor vehicle traffic accident due to loss of control, without collision on the highway; passenger in motor vehicle other than motorcycle) to 99282  to show the patient was in an accident.

- attach V71.4 (Observation following other accident) to 99282 to show that the physician observed the patient after an accident.

However, if the patient has any symptoms at all, you would slide V15.85 into the secondary position.

For instance, let's say the patient that was exposed to the blood also complains of pain near her ribs during the encounter. The physician performs a level 2 E/M, checking the patient's shoulder in addition to examining her exposure to blood.

On the claim, you would:

- report 99282 for the E/M.

- attach ICD-9 786.50 (Chest  pain, unspecified) code to 992823 to represent the patient's rib pain.

- attach ICD-9 code V15.85 to show the patient was also exposed to blood.

- attach ICD-9 code E816.1 to 99283 to show the patient was in an accident.

- attach V71.4 to 99283 to show that the physician observed the patient after an accident.