ED Coding and Reimbursement Alert
Make Separate Nature Clear, Give I&D -- E/M Claims Wings
Question: A patient reports to the ED with a cyst in the mucosal tissue of her left cheek. The ED physician performs a level-two E/M service, diagnoses an intra oral hematoma, and then uses a scalpel to cut a tiny slit in the wound to drain it; the wound is not infected. Can I report a separate code for the incision and drainage (I&D) of the hematoma, or is it part of the E/M? Nevada Subscriber Answer: As long as the notes prove a significant, separately identifiable E/M service, then both the ED E/M and the I&D should stand up to payer scrutiny. On the claim, report the following: 40800 (Drainage of abscess, cyst, hematoma, vestibule of mouth; simple) for the I&D 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 I&D and E/M were separate services 920 (Contusion of face, scalp, and neck except eye[s]) appended to 40800 and 99282 to represent the patient's hematoma
ED Coding and Reimbursement Alert
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