tci ED Coding & Reimbursement Alert - 2001 Issue 6

Reader Question: Level-five Caveat

Question: Does the ED level-five caveat apply to the physical exam as well as the history? Must the physician state unable to obtain or due to the patients condition the only organ systems examined were those pertaining to critical care? Can the level-five caveat be inferred based on the patients condition or present problem?Cheryl GrossmanPhoenixAnswer: According to CPT descriptors, the level-five caveat (limited documentation due to the condition of the patient) applies to all key elements of ED E/M levels when documented appropriately. Physicians must: 1) document which areas are incomplete, and 2) clearly state the reason(s) why...

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