tci ED Coding & Reimbursement Alert - 2011 Issue 5

E/M coding: Salvage Your 99285 Claims With This Can't-Miss Caveat

Beware: This ED exception has strict documentation requirements.A patient reports to the ED with a severe illness or injury. Encounter notes indicate that the physician provided a comprehensive exam and high-level medical decision making (MDM) ... but the history documentation is limited.What do you do? The level five ED acuity caveat, a very specific coding exception, could help you code this service as a 99285 " provided the encounter notes reflect a level-five exam and MDM.Before using the ED caveat, however, you need to know when you can " and can't " invoke this inception. If you...

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