ED Coding and Reimbursement Alert

Question: A patient recovering from a spinal tap procedure he had two weeks ago reports to the ED with a severe headache. After a level-four E/M service, the ED physician diagnoses a post-spinal procedure headache. The anesthesiologist examines the patient and decides to perform a blood patch epidural. Can we report an E/M for the ED physician and a code for the blood patch as well? Kentucky Subscriber Answer: You should be able to report a code for the E/M service because the ED physician had to perform a significant E/M before deciding on the course of care. In this case, the anesthesiologist is performing the blood patch, so the ED physician should not bill for that procedure (62273, Injection, epidural, of blood or clot patch). On the claim, report the following: - 99284 (Emergency department visit for the evaluation and management of a patient, which requires these three key components: a detailed history; a detailed examination; and medical decision-making of moderate complexity) for the E/M - 349.0 (Reaction to spinal or lumbar procedure) linked to 99284 to represent the patient's headache.