tci ED Coding & Reimbursement Alert - 2000 Issue 8

Medical Decision-Making Is Key Factor in Determining Level of E/M Reimbursement

One could argue that every heart attack (410.9) that comes into the emergency department justifies a level five (99285) evaluation and management (E/M) code. Unfortunately, the documentation too often fails to reflect the level of medical decision-making spent on the case. Emergency department (ED) physicians should take the time to thoroughly document the complexity of each case to indicate the level of medical decision-making involved in providing emergency treatment. This will optimize reimbursement and provide backup in case of an audit. How important is medical decision-making? I think its the primary factor, says Sam Roberts, MD, FACEP, president...

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