ED Coding and Reimbursement Alert

Question: A patient with type II diabetes reported to the ED complaining of a severe headache and neck pain. The physician performed a level-four evaluation and management service, including a CT scan and a check of blood sugar, prescribed some pain medication, gave the patient a dose of glucophage because he had missed his morning pill, and sent him home. Should we include a diagnosis code for diabetes?

Missouri Subscriber

Answer: It depends on the situation. Diabetes is a chronic condition, and you should only report ICD-9 codes for chronic conditions when they are relevant to the service the physician provides.

In your scenario, if the physician had to consider the diabetes when prescribing medication, or for any other reason, you should:

- report 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.

- link 784.0 (Headache) to 99284 to represent the patient's headache.

- link 723.1 (Cervicalgia) to 99284 to represent the patient's neck pain.

- link 250.00 (Diabetes mellitus without mention of complication; type II or unspecified type, not stated as uncontrolled) to 99284 to represent the patient's diabetes.
 
But if the diabetes does not affect the physician's treatment options, you should:

- report 99284 for the E/M.

- link 784.0 to 99284 to represent the patient's headache.

- link 723.1 to 99284 to represent the patient's neck pain.