ED Coding and Reimbursement Alert

Question: An asymptomatic patient presented to the ED needing a medication refill. Which E/M level should I report?

Maine Subscriber Answer: Generally, these situations qualify for low-level visit codes - such as 99281 (Emergency department visit for the evaluation and management of a patient, which requires these three key components: a problem-focused history, a problem- focused examination, and straightforward medical decision-making) or 99282 (... an expanded problem-focused history, an expanded problem-focused examination, and medical decision-making of low complexity) - unless the patient has an additional complaint that warrants further investigation by the physician.

However, because prescription drug management is involved in this case, the visit may qualify for moderate medical decision-making. Depending on the documentation the doctor provided, 99283 (... an expanded problem-focused history, an expanded problem-focused examination, and medical decision-making of moderate complexity) or 99284 (... a detailed history, a detailed examination, and medical decision-making of moderate complexity) might apply. Many groups pick the lower code, given that many times not much work is involved in caring for these patients.