ED Coding and Reimbursement Alert

Question: A patient reports to the ED complaining of chest pain (directly over the heart) after possibly bumping his chest. After a level-three E/M, the physician orders a single-view chest x-ray. The x-ray confirms that the patient did not have a cardiac episode; the notes, however, indicate that the patient had an angioplasty 12 years ago and the physician describes this consideration in the medical decision making. Do I need to note the patient's previous heart procedure on the claim? Minnesota Subscriber Answer: Although the patient did not have a heart attack, you should include a V code (V45.82, Percutaneous transluminal coronary angioplasty status) to represent the patient's past angioplasty. Reasoning: The past angioplasty is part of the patient's medical history -- and because the patient reported for chest trouble, it likely affected the ED physician's medical decision making. On the claim, report the following: - 71010 (Radiologic examination, chest; single [...]