ED Coding and Reimbursement Alert

'Aggressive monitoring' might add digits to E/M level.

Patients reporting to the ED for burn treatment almost always require a separate E/M service in addition to the treatment, which results in more deserved reimbursement for your practice. Many of these patients will receive a low-level E/M service along with a 160xx service. There are certain situations, however, in which the physician might provide a highlevel E/M in addition to burn treatment, confirms Sharon Richardson, RN, coder in the compliance office of Emergency Groups' Office in Arcadia, Calif.

In addition to 16000-16030, these encounters might also include 99285 (Emergency department visit for the evaluation and management of a patient, which requires these 3 key components within the constraints imposed by the urgency of the patient's clinical condition and/or mental status: a comprehensive history; a comprehensive examination; and medical decision making of high complexity ...) or 99291 (Critical care, evaluation and management of the critically ill or critically injured patient; first 30-74 minutes) service.

When? If the patient suffers from chemical poisoning, smoke inhalation, etc., in addition to the burn, he may need extensivemanagement and monitoring, explains Richardson.

For example, a patient suffers an electrical burn that causes an arrhythmia, which requires aggressive rehydration and replacement of electrolytes. The E/M for this encounter might be high, considering the patient's condition.

Modifier alert: Regardless of E/M code choice, make sure you append modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) appended to the ED E/M code to show that it was a separate service from the burn treatment.