EM Coding Alert

Question: A patient visits the ED in the morning for a fever, nausea, and vomiting, and the physician performs a level-three ED E/M. The same patient arrives at the ED again that evening after falling on his sidewalk and down his front steps, causing severe abrasions and a possible broken bone. The physician's notes for the patient's second visit indicate a level-four ED E/M. Can we code two ED E/M encounters for the same patient on the same day? If so, which ED E/M codes should we report?

Ohio Subscriber

Answer: Yes. You can report two ED E/M codes for the same patient on the same date if the situation allows.

In this case, you will report 99283 (Emergency department visitfor the evaluation and management of a patient, which requires these 3 key components: an expanded problem focused history; an expanded problem focused examination; and medical decision making of moderate complexity ...) for the first visit and 99284 (... a detailed history; a detailed examination; and medical decision making of moderate complexity...) for the second visit.

Since these two separate encounters address two different issues, some payers will let you code for both services without a modifier. However, other payers may require you to append modifier 25 (Significant, separately identifiable evaluation and management service by the same physician or other qualified health care professional on the same day of the procedure or other service) to the second ED E/M. Always check with your payer if you are unsure about using modifier 25 on multiple ED E/M claims.

Some payers may deny the second claim if both encounters are for the same diagnosis, but based on the principle that every presentation to the ED is a new and separate visit, if the patient presents twice, you can code both encounters.

Note:  Be sure to indicate to the payer that each ED visit on the same date is for a separate incident - even if both incidents involve the same diagnoses.