ED Coding and Reimbursement Alert

Jaw pain, drug OD codes highlight new ED-relevant Dxs.

On Oct. 1, ED coders will have several more arrows in their coding quivers to prove high-level ED E/Ms.

Reason: That's the date you'll start using ICD-9 2011. "Many of these new codes will provide a coder with the tools required to demonstrate medical necessity for some of our higherlevel ED encounters," explains Michael Granovsky, MD, CPC, FACEP, president of MRSI, an ED coding and billing company in Woburn, Mass.

The following new codes are most relevant to the ED, according to Granovsky:

• 276.69 (Other fluid overload)
• 724.03 (Spinal stenosis, lumbar region, with neurogenicclaudication)
• 780.33 (Post traumatic seizures)
• 784.92 (Jaw pain)
• 786.30 (Hemoptysis, unspecified)
• 799.50 (Unspecified signs and symptoms involving cognition)
• 970.81 (Poisoning by cocaine)
• 970.89 (Poisoning by other central nervous system; stimulants).

(Note: Look for more information on using these new ICD-9 codes in future issues of ED Coding Alert.) Check Out This Drug Poisoning Dx Example The new ICD-9 codes most likely to trigger a critical care scenario are "those associated with post-traumatic seizures and poisonings by cocaine or CNS [central nervous system] stimulants," Granovsky explains.

"These patients can be very complex, extremely sick," and are potential critical care cases, he continues. Consider this detailed clinical example from Sarah Todt, RN, CPC, CEDC, director of education and compliance for MRSI.

A 22-year-old patient presents with acute chest pain and hypertension. History reveals that he inhaled four lines of cocaine within the past hour and has been abusing cocaine for the past year.The physician performs and documents a comprehensive history and exam.

Diagnostics include a cardiac panel and drug screen, and an electrocardiogram (EKG) reveals ST elevation in the anterior leads. Lab work shows elevated CPK and troponin. The physician treats the patient with intravenous Valium and starts him on a nitroglycerin drip. The physician then admits the patient to the critical care unit with anterior wall ST segment elevation myocardial infarction (STEMI) due to cocaine poisoning and hypertension. The physician reports 45 minutes of critical care time.

After Oct. 1, you'll report the following for this encounter:

• 99291 (Critical care, evaluation and management of the critically ill or critically injured patient; first 30-74 minutes) for the critical care
• 410.11 (Acute myocardial infarction; of other anterior wall; initial episode of care) appended to 99291 to represent the patient's MI
• 970.81 appended to 99291 to represent the patient's cocaine poisoning
• 401.9 (Essential hypertension; unspecified) appended to 99291 to represent the patient's hypertension.