ED Coding and Reimbursement Alert

Question: We have doctors who use extravasation of contrast material as a diagnosis. I interpret this to mean that the patient entered the emergency department (ED) because of a complication of the above procedure. Is this correct? If so, what should the doctors document as the proper diagnosis?

Diane Valenzuela
Sunwest Billing Service, El Paso, Texas

Answer: According to Tabers Encyclopedic Medical Dictionary, extravasation is the escape of fluids into the surrounding tissues. Your question suggests that a patient is coming to the ED after a radiologic procedure that used contrast material, and that the contrast material is leaking into another area of the body, says Lamon Willis, CPC, a consultant in Jacksonville, Fla., who specializes in ED physician coding.

There are several diagnoses that can be used and are listed in the ICD-9 manual under the extravasation heading in the index. You must determine, however, whether the patient has a complication of the contrast material/radiologic procedure or a hemorrhagic condition. Only then can you steer your doctor toward a clear diagnosis for billing purposes.