tci ED Coding & Reimbursement Alert - 2010 Issue 12

ED E/M Coding: 99281-99285: Use NOPP Info to Accurately - Choose MDM Level -- and E/M Code

5 levels of NOPP don't always line up with ED E/M. If you don't have a firm grasp on nature of presenting problems (NOPP) levels, you won't be able to choose the most accurate ED E/M code possible for each claim. Why? It's the lynchpin in deciding medical necessity for an E/M service; without accurate NOPP level, you cannot decide on medical necessity for the encounter. "Medicare and insurers will only reimburse for care that is 'medically necessary.' CPT defines medical necessity by the nature of the presenting problem," explains Mary Falbo, MBA, CPC, president of Millennium...

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