ED Coding and Reimbursement Alert

Question: A patient reports to the ED with a crayon stuck in his left nostril. The physician performs an expanded problem focused history and exam, noting the airway patency; she then performs a lung exam to evaluate for aspiration and wheezing. The  physician removes the crayon using small forceps. Is this an ED E/M service, or does this work warrant a procedure code?

Iowa Subscriber

Answer: The child requires an Emergency Medical Treatment and Active Labor Act (EMTALA)-mandated screening exam to check for any other injuries, as well as an evaluation for complications of the foreign body insertion.

Report a procedure code as well as an E/M code for your physician's services. On the claim, report the following:

• 30300 (Removal foreign body, intranasal; office type procedure) for the foreign body removal (FBR)
• 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
• modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) appended to 99282 to show that the E/M and the FBR were separate services
• 932 (Foreign body in nose) appended to 30300 and 99282 to represent the FB.

-- Reader Questions and You Be the Coder reviewed by Michael A. Granovsky, MD, CPC, FACEP, president of MRSI, an ED coding and billing company in Woburn, Mass.