ED Coding and Reimbursement Alert

Question: A patient reports to the ED with chest pain. During the course of an ED evaluation and management (E/M) service, the physician orders an electrocardiogram (ECG) and a complete chest X-ray. The physician does not note a cardiac event, but does diagnose the patient with angina pectoris; notes indicate a moderate level of medical decision making during the encounter.

Just as the patient is being discharged, they collapse in cardiac arrest. The physician performs 60 minutes of critical care for the patient, whose diagnosis has changed to cerebral infarction (CI) due to thrombosis of the vertebral artery.

How should I report this encounter? Can I code the E/M and the critical care?

AAPC Forum Subscriber

Answer: Yes, you can report both services. On the claim, report:

• 99284 (Emergency department visit for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and moderate level of medical decision making) for the E/M service
• I20.9 (Angina pectoris, unspecified) appended to 99284 to represent the patient’s angina pectoris
• 99291 (Critical care, evaluation and management of the critically ill or critically injured patient; first 30-74 minutes) for the critical care
• I63.01 (Cerebral infarction due to thrombosis of vertebral artery) appended to 99291 to represent the patient’s CI
• Modifier 25 (Significant, separately identifiable evaluation and management service by the same physician or other qualified health care professional on the same day of the procedure or other service) appended to 99291 to show that the ED E/M and the critical care were significant and separately identifiable services

Explanation: CPT^® explicitly allows you to report ED critical care on the same day as an E/M service if the E/M precedes the critical care. Per the 2024 code book (Emphasis added): “Critical care and emergency department services may both be reported on the same day when after completion of the emergency department service, the condition of the patient changes and critical care services are provided.”