ED Coding and Reimbursement Alert

Question: A 55-year-old patient reports to the ED, saying that for the past three weeks, he has "zoned out" for no reason several times, but did not lose consciousness during any of the episodes. The physician provides a level three E/M, diagnoses "episodic abnormality of consciousness; etiology uncertain," and refers the patient to a neurologist. Which ICD-9 codes apply to this condition? Oregon Subscriber Answer: According to ICD-9, use 780.02 (Alteration of consciousness; transient alteration of awareness) when a patient experiences "temporary, recurring spells of reduced consciousness." Given your description, this is the best diagnosis for the patient. On the claim, report 99283 (Emergency department visit for the evaluation and management of a patient, which requires these 3 key components: an expanded problem focused history; an expanded problem focused examination; and medical decision making of moderate complexity ...) with 780.02 appended.