ED Coding and Reimbursement Alert

Question: I need some ICD-9 help for this claim. A patient reports to the ED complaining of throat pain. After performing a level-three evaluation and management  service, the physician makes a diagnosis of foreign-body sensation in the throat. She then performs a diagnostic flexible laryngoscopy. Is there a diagnosis code for FB sensation in the throat?


Mississippi Subscriber



Answer: Since there is no exact ICD-9 code to match FB sensation in the throat, you should choose from a pair of diagnosis codes that closely match the symptoms of FB sensation. The two ICD-9 codes that most closely resemble your patient's symptoms are:

- 784.1--Throat pain

- 784.99--Other symptoms involving head and neck. Which code you choose will probably depend on the payer's preference. If you don't know your payer's policy on diagnosis coding for FB sensation in the throat, contact a representative to make sure.

Suppose the insurer allows 784.1 when you report a patient's FB sensation in the throat. On the claim,

- report 31575 (Laryngoscopy, flexible fiberoptic; diagnostic) for the laryngoscopy.

- report 99283 (Emergency department visit for the evaluation and management of a patient, which requires these three key components: an expanded problem-focused history; an expanded problem-focused examination; and medical decision-making of moderate complexity) for the E/M service.

- link 784.1 to 31575 and 99283 to prove medical necessity for both services.

- attach modifier 25 (Significant, separately identifiable evaluation and management service ...) to 99283 to show that the laryngoscopy and the E/M were significantly separate services.