ED Coding and Reimbursement Alert
NOPP Can Push Physician's MDM Up
Question: A 45-year-old male patient reports to the ED with chest pain and mild shortness of breath; the physician's initial clinical judgment is a possible cardiac etiology , so he performs a comprehensive history and exam, as well as ordering labs, a two view chest x-ray, and an electrocardiogram (EKG). The workup reveals no cardiac condition, but rather severe indigestion. The physician orders a GI "cocktail" and sends the patient home. How should I code this encounter? Washington, DC Subscriber Answer: Since the nature of the presenting problem (NOPP) was so high for this patient (possible heart attack), this is likely a high-complexity medical decision making encounter. Go back and check the notes to ensure that the MDM was high-level. If that is the case, report the following: 99285 (Emergency department visit for the evaluation and management of a patient, which requires these 3 key components 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 ED E/M 787.1 (Symptoms involving digestive system; heartburn ) 786.50 (Chest pain, unspecified) 786.05 (Dyspnea and respiratory abnormalities; shortness of breath). If the notes do not indicate high-complexity MDM, however, you'll code 99284 (... a detailed history; a detailed examination; medical decisions making of moderate complexity ...) instead.
ED Coding and Reimbursement Alert
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