Three significant changes that will affect reimbursement rates go into effect January 1, 2026:
Conversion factor changes
Relative Value Unit (RVU) efficiency adjustment
Practice Expense changes
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tci ED Coding & Reimbursement Alert - 2001 Issue 4
Reader Question: E/M for URI
Question: Which level 99282 or 99283 would I code an ED visit for a child who presented with a URI (upper respiratory infection) and fever (fever measurement in ED not documented)? An exam was done, no tests were done, and no prescriptions given. Are the final diagnoses URI and fever? I believe the medical decision-making does not warrant a level three, but I have heard that two diagnoses increase the level. Camille VillanuevaCape Coral, Fla.Answer: The diagnoses do not affect the level of service. The issue in this case is the level of medical decision-making because the history...
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