Question

A 10-year-old presents having fallen approximately 2 hours ago. Ice was applied, however, swelling and pain continues. ED physician performs ROS involving four systems. Patient lives at home and attends grade school in the area. Multiple systems are evaluated. Multiple x-rays are obtained as well as labs and independent evaluation of x-rays and discussion of case with another health care provider. The ED physician performs conscious moderate sedation for 30 minutes that is monitored and documented appropriately. The fracture is reduced and casted by the orthopedist. What are the appropriate E/M services for the ED physician for this encounter?

A. 99284-25, 99156, 99157
B. 99284, 99151, 99152
C. 99283-25, 99156, 99157
D. 99283

Answer 1

The correct E/M services for the ED physician in this case are 99284-25 for the detailed ED visit, 99156 for the first hour of moderate sedation, and 99157 for each additional 15 minutes of sedation.

Step-by-step explanation:

The appropriate Evaluation and Management (E/M) services for the Emergency Department (ED) physician in this scenario are 99284-25, 99156, 99157. This code reflects a high severity ED visit that requires a detailed history and examination (99284). The -25 modifier is used to indicate that a significant, separately identifiable E/M service was provided on the same day as the conscious sedation. Codes 99156 and 99157 represent the first hour of physician provided moderate sedation for a patient less than 5 years old, and each additional 15 minutes of sedation, respectively. These E/M codes accurately represent the ED physician’s assessment and provision of moderate sedation, as well as their extensive evaluation across multiple systems.