Internal Medicine Coding Alert

Published on Fri Aug 27, 2010 PDF

Try your hand at this critical care scenario.

When an internist in the emergency department takes care for a patient with cocaine poisoning, do you know what to do? A new code effective Oct. 1, 2010, changes what you should report.

Here's what's new: When ICD-9 2011 goes into effect Oct. 1, you can expect to see 970.81 (Poisoning by central nervous stimulants; cocaine) available for when you need to report cocaine poisoning.

Conquer This Critical Care Scenario

Patients with cocaine poisoning "can be very complex, extremely sick," and are potential critical care cases, says Michael A. Granovsky, MD, CPC, FACEP, president of MRSI, an ED coding and billing company in Woburn, Mass. Consider this detailed example from Sarah Todt, RN, CPC, CEDC, director of education and compliance for MRSI.

Scenario: A 22-year-old patient presents with acute chest pain and hypertension. History reveals that he inhaled four lines of cocaine within the past hour and has been abusing cocaine for the past year. The internist performs and documents a comprehensive history and exam.

Diagnostics include a cardiac panel and drug screen, and an electrocardiogram (ECG) reveals ST elevation in the anterior leads. Lab work shows elevated CPK (creatine phosphokinase) and troponin. The internist treats the patient with intravenous Valium and starts him on a nitroglycerin drip. The physician then admits the patient to the critical care unit with anterior wall ST segment elevation myocardial infarction (STEMI) due to cocaine poisoning and hypertension. He also reports 45 minutes of critical care time.

Solution: You should report the following for this encounter:

• 99291 (Critical care, evaluation and management of the critically ill or critically injured patient; first
• 30-74 minutes) for the 45 minutes of critical care
• 410.11 (Acute myocardial infarction; of other anterior wall; initial episode of care) attached to 99291 to represent the patient's MI
• 970.81 (Poisoning by central nervous stimulants; cocaine) appended to 99291 to represent the patient's cocaine poisoning
• 401.9 (Essential hypertension; unspecified) appended to 99291 to represent the patient's hypertension.