Practice Management Alert

Question: Our ED recently treated two patients who sustained injuries when their car veered off the highway. There was also a third passenger in the vehicle who was not clearly hurt, but she had to be fully evaluated due to the severity of the accident. The physician performed a level 2 evaluation and management service before releasing the non-injured patient. How can we prove medical necessity for the E/M service?

North Carolina Subscriber

Answer: You may use a V code as a primary diagnosis since the patient is asymptomatic. On your claim report:

• 99282 (Emergency department visit for the evaluation and management of a patient, which requires these three key components: a problem focused history; a problem focused examination; and straightforward complexity medical decision making) for the E/M.
  
• Attach ICD-9 code V71.4 (Observation following other accident) to 99282 to represent the reasons for the patient’s visit.
  
• Attach ICD-9 code E816.1 (Motor vehicle traffic accident due to loss of control, without collision on the highway injuring passenger in motor vehicle other than motorcycle) to 99282 to show the patient was in an accident.
  

Keep in mind, if the patient has any symptoms at all, you would that symptom as the primary diagnosis. As an example, if the patient that was in the MVA complained of pain near her ribs during the encounter. The physician performs a level 3 E/M, checking the patient’s chest area for injury in addition to examining her exposure to blood.

On the claim, you would:

• Report 99283 (Emergency department visit for the evaluation and management of a patient, which requires these three key components: a problem focused history; a problem focused examination; and medical decision making of moderate complexity) for the E/M.
  
• Attach ICD-9 786.50 (Rib [chest] pain, unspecified) code to 992823 to represent the patient’s rib pain.
  
• Attach ICD-9 code E816.1 (Motor vehicle traffic accident due to loss of control, without collision on the highway injuring passenger in motor vehicle other than motorcycle) to 99283 to show the patient was in an accident.