ED Coding and Reimbursement Alert

Question: A patient with osteoporosis reports to the ED complaining of wrist pain. The physician inspects the patient's wrist, diagnoses bursitis, and performs an arthrocentesis injection with 40 mg of Sano-Drol. Can I report a separate E/M in this scenario? Alabama Subscriber Answer: Yes, you can report an E/M. Since patients do not report to the ED for scheduled procedures, the work the physician performs pre-procedure is almost always a separate E/M. In your scenario, the work the physician performs diagnosing the bursitis is considered a separate E/M. On the claim, report the following: - 20605 (Arthrocentesis, aspiration and/or injection;intermediate joint or bursa [e.g., temporomandibular,acromioclavicular, wrist, elbow or ankle, olecranon bursa]) for the arthrocentesis - the appropriate level E/M code based on the encounter notes, such as 99282 (Emergency department visit for the evaluation and management of a patient,which requires these 3 key components: an expanded problem focused history; an [...]