ED Coding and Reimbursement Alert

Question: A patient reports to the ED with complaints of fever, decreased urine output, and a skin rash. Suspecting sepsis, the ED physician orders a twoview chest x-ray, inserts a Foley catheter (due to nurse difficulty with the procedure), and orders blood collection for testing. After reviewing the labs and x-ray results, the physician detects impaired oxygen availability in the patient's blood; final diagnosis is "SIRS, no organ dysfunction." What condition does this note describe, and what services can I report separately from the E/M service?

Oregon Subscriber

Answer: The patient has a form of sepsis, which you'll report with a 995.9x code. On the claim, report the following:

• 71020 (Radiologic examination, chest, 2 views, frontal and lateral) for the x-ray

• modifier 26 (Professional component) appended to 71020 to show that you are coding only for the physician's services

• 51702 (Insertion of temporary indwelling bladder catheter; simple [e.g., Foley]) for the catheterization

• the appropriate-level ED E/M code based on notes, such as 99285 (Emergency department visit for the evaluation and management of a patient, which requires these 3 key components ...)

• 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 the E/M to show that the E/M was a separate service from the x-ray and cath.

• 995.91 (Systemic inflammatory response syndrome [SIRS]; sepsis) appended to the E/M and 71020 to represent the patient's condition.