EM Coding Alert

Question: The patient reported to the ED in the morning for a fever and nausea and vomiting, and the physician performed a level-three ED E/M. That evening, the same patient arrived again at the ED after falling on her sidewalk and down a few steps, causing severe abrasions and a possible broken bone. Notes for the second visit indicated a level-four ED E/M. Which codes should we report?

Nebraska Subscriber

Answer: You would report 99283 (... 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.

Because these are two separate encounters that address two separate issues, some payers will allow you to code for both services without a modifier. Others, however, will 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. Check with your payer if you are unsure about using modifier 25 on multiple ED E/M claims.

Best bet:  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. Thorough and complete notes on both encounters will be essential to helping ease the claim through to proper adjudication.