ED Coding and Reimbursement Alert

Question: A patient complaining of rectal bleeding reports to the ED. After a level-five E/M, the physician personally performs a gastric aspiration to determine if the bleeding is from the upper or lower GI tract. He performs the aspiration after the nurse is unable to complete the procedure. How should I code this service? Nevada Subscriber Answer: The proper code for gastric aspiration is 91105 (Gastric intubation, and aspiration or lavage for treatment [e.g., for ingested poisons]). In addition to 91105, be sure to report the following: - 99285 (Emergency department visit for the evaluation and management of a patient, which requires these three key components within the constraints imposed by the urgency of the patient's clinical condition and/or mental status: a comprehensive history; a comprehensive examination; and medical decision-making of high complexity) for the E/M. - modifier 25 (significant, separately identifiable E/M service by the same physician on the same day of the procedure or other service) linked to 99285 to show that the E/M and aspiration were separate services - 569.3 (Hemorrhage of rectum and anus) linked to 91105 and 99285 to represent the patient's symptoms.