ED Coding and Reimbursement Alert

Question: A patient with tightness in his chest and labored breathing reports to the ED. During the course of the E/M service, the ED physician performs a carotid massage. Two questions: What is a carotid massage, and should I code it separately from the E/M? Virginia Subscriber Answer: A carotid massage occurs when the physician presses the carotid sinus in order to slow a patient's heart rate. Patients may require this treatment to slow an accelerated heart beat. As per your coding question, there currently exists no CPT procedural code for carotid massage. When your ED physician performs this therapy, roll the work into the E/M service. So if the entire encounter notes indicate a level-four E/M, report 99284 (Emergency department visit for the evaluation and management of a patient, which requires these 3 key components: a detailed history; a detailed examination; and medical decision-making of moderate complexity) for the entire encounter. Remember to attach ICD-9 codes 786.59 (Chest pain; other) and 786.09 (Symptoms involving respiratory system and other chest symptoms; dyspnea and respiratory abnormalities; other) to the E/M code to represent the patient's symptoms.