ED Coding and Reimbursement Alert

Question: A woman arrives at the ED having already delivered a baby. Our ED physician conducts a history and physical on the patient after delivering the placenta. Notes indicate a level-two E/M service, but I don't know if the E/M is separately reportable in this case. What should we report?


Michigan Subscriber

 
Answer: If the physician provides the postpartum care follow-up (hospital and office visits following delivery), you can report a pair of codes. This is not common in the ED; more likely, you would report an ED E/M. On the claim:

- report 59414 (Delivery of placenta [separate procedure]) for the placenta delivery.

- report 99282 (Emergency department visit for the E/M of a patient, which requires these three key components: an expanded problem-focused history, an expanded problem-focused examination, and medical decision-making of low complexity) for the E/M service.

- append modifier 25 (Significant, separately identifiable E/M service by the same physician on the same day of the procedure or other service) to 99282 to show that it was a separate service from 59414.
 
Reader Questions and You Be the Coder reviewed by Michael A. Granovsky, MD, CPC, FACEP, vice president of Medical Reimbursement Systems Inc., an ED coding and billing company in Stoneham, Mass.