Neurology & Pain Management Coding Alert

Question: We had an emergency in our office when a patient had a seizure during an exam, fell and hit his head on the floor. The doctor administered emergency care while waiting for the ambulance. The established patient evaluation and management (E/M) visit codes dont seem appropriate, but neither do the codes for emergency department visits. How should we code this?

Wisconsin Subscriber

Answer: The most appropriate code is 99215 (office or other outpatient visit for the evaluation and management of an established patient; presenting problems are usually of moderate to high severity) provided the E/M service rendered and documented by the physician was appropriate for selecting that level of service based on the history, exam and medical decision making. (Note: For established patient, only two out of the three key components are needed). The situation probably does not warrant critical care services (99291-99292), and the emergency department codes (99281-99285) cannot be billed in the physicians office.

Answered by Brenda Messick, CPC, senior consultant at Gates, Moore & Co., a physician practice management and reimbursement consulting firm in Atlanta.