tci ED Coding & Reimbursement Alert - 2023 Issue Q1

E/M Coding: Calculate Tetanus Shot MDM Risk Carefully

How should a tetanus shot factor into calculating MDM risk? When coding an evaluation and management (E/M) service, coders must calculate the level of medical decision making (MDM) associated with the patient’s care. According to Todd Thomas, CPC, CCS-P, president of ERcoder, Inc., in Edmond, Oklahoma: “While we are currently in a transition period as ED coders are preparing for the implementation of the 2023 E/M guidelines, current and future MDM requirements include ‘risk of complications and/or morbidity or mortality’ as part of assigning a value to the MDM.” Where a tetanus shot fits into...

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