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ED Coding and Reimbursement Alert

READER QUESTIONS:

Code Pair Provides Pinpoint Pressure Ulcer Dx

Published on Sun Nov 27, 2011

Question: A 75-year-old reports to the ED for inspection of sores on her back. The nonphysician practitioner (NPP) performs an expanded problem focused history and an expanded problem focused exam, and then diagnoses a stage I pressure ulcer on her lower back. The NPP refers the patient to a dermatologist for treatment of the ulcer. How should I report this diagnosis? Indiana Subscriber Answer: You should submit a pair of codes; one to represent the stage of the pressure ulcer, and another for the ulcer itself. On the claim, report the following: • 99282 (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 low complexity ...) for the E/M • 707.03 (Pressure ulcer; lower back) appended to 99282 to represent the pressure ulcer • 707.21 (Pressure ulcer [...]
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