E/M Coding Clinic:
Get Paid for Many Low-level ED Services with Code 99281
Published on Sun Aug 01, 1999
Editors Note: One of the most complicated duties for an emergency medicine coder is reporting evaluation and management services performed in the ED. In this and following issues, we will feature an article devoted to each emergency service evaluation and management (E/M) code (99281-99285), outlining typical services provided at that level and the documentation required for each.
A 6-year-old with no history of allergic reaction presents to the ED with several small, uncomplicated ant bites to the wrist. A 16-year-old comes in for a tetanus immunization as a preventive measure for a minor puncture wound. These are some typical ED visits that would most likely be reported with the E/M Code 99281 (emergency department visit for the evaluation and management of a patient, which requires these three key components: problem-focused history; problem-focused examination; and straightforward medical decision-making).
Most of these are patients who dont have primary care physicians (PCPs) or cant get there due to a weekend or holiday or that office is too busy, states Charlene Day, BS, CMA, CMM, CPC, director of professional relations for Team Physicians of Arizona, an emergency physician group in Phoenix.
According to CPT, the presenting problems for this code are usually self-limiting and minor. A 99281 service that is specific to many EDs is the situation in which a patient is dead on arrival (DOA) at the department and the physician does not perform a workup but just officially pronounces the death.
Note: In many areas, ambulance and EMS personnel
are not authorized to legally pronounce a person dead. So, even if a person were killed instantly in an automobile accident, for example, he or she would be transported to the ED for the physician to pronounce the death and sign the death certificate.
[Pronouncing the patient dead] is very controversial because some groups dont charge for this, and some actually document any exam the physician does and charge at a higher level, notes Day.
Limited Documentation is Acceptable
Medicare utilization figures indicate 99281 is not frequently reported. Underreporting could arise because many possible 99281 visits are written off as no charge, says Day. Coders may feel that the medical record cant be coded even to that minimal level due to poor documentation, but in actuality a Level 1 is easy to meet. In most cases, even the poorest documentation should support that code.
When 99281 is overreported, it is usually due to coders being very conservative and reporting this level when the medical record would actually support a Level 2 or Level 3, she [...]
