ED Coding and Reimbursement Alert

Question: A patient presents with a headache and severe vomiting. After a non-automated urinalysis without microscopy, the physician diagnoses gastroenteritis. Notes indicate a level-three E/M service. Should I report all three diagnosis codes, or just one for gastroenteritis? Nebraska Subscriber Answer: If all three symptoms were present in the patient during the ED visit, you should report all three -- but remember that ED practices do not code for the urinalysis, only the E/M. On the claim, report the following: - 99283 (Emergency department visit for the evaluation and management of a patient, which requires these three key components: an expanded problem-focused history; an expanded problem-focused examination; and medical decision making of moderate complexity) for the E/M - 558.9 (Other and unspecified noninfectious gastroenteritis and colitis) appended to 99283 to represent the gastroenteritis - 787.01 (Nausea with vomiting) appended to 99283 to represent the vomiting - 784.0 (Headache) appended to 99283 to represent the headache. Reason: This diagnosis coding tells a complete sequential story of the ED encounter: The patient has symptoms that the ED physician addresses through E/M; based on the E/M, the physician performs a screening and reaches a diagnosis.