ED Coding and Reimbursement Alert

Question: A substantial number of people who report to our ED after auto accidents end up having no injuries. How do we code for these patients, without a definitive diagnosis?

Tennessee Subscriber

Answer: You should append at least the following diagnosis codes to the E/M code to ensure that you'll be paid for these "injury-free" patients:

V71.4 (Observation and evaluation for suspected conditions not found; observation following other accident) to represent the reason for the presentation the appropriate E code to represent the MVA For example, a 68-year-old patient reports to the ED after being the driver in a low-speed MVA; he ran off the side of the road, then overcompensated and hit another car. The patient reports no outward symptoms but "wanted to make sure." A qualified nonphysician practitioner (NPP) performs an expanded problemfocused history and exam but finds nothing wrong with the patient.

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 moderate medical decision making ...) for the E/M
• V71.4 appended to 99281 to represent the reason for the presentation
• E811.0 (Motor vehicle traffic accident involving reentrant collision with another motor vehicle; injuring driver of motor vehicle other than motorcycle) appended to 99283 to represent the type of accident that occurred.