ED Coding and Reimbursement Alert

Question: A patient reports to the ED via ambulance. The emergency medical technician (EMT) says the patient had sudden chest pain, rapid heart rate and rapid breathing. The physician orders a two-view chest x-ray, and diagnoses a spontaneous pneumothorax. Encounter notes indicate that the physician used "needle to chest for spontaneous pneumothorax." Notes indicate the encounter included a level-five E/M service. How should I code this encounter?

Montana Subscriber

Answer: You physician performed a needle thoracentesis for this patient's collapsed lung. On the claim, report the following:

• 32421 (Thoracentesis, puncture of pleural cavity for aspiration, initial or subsequent) for the thoracentesis
• 71020 (Radiologic examination, chest, 2 views, frontal and lateral;) for the x-ray
• Modifier 26 (Professional component) appended to 71020 to show that the physician is only billing for his interpretation of the x-ray
• 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 99284 to show that the E/M, x-ray, and thoracentesis were separate services
• 512.8 (Pneumothorax; other spontaneous pneumothorax) appended to 32421, 72020 and 99285 to represent the patient's condition.