tci ED Coding & Reimbursement Alert - 2009 Issue 1

Reader Questions: Apply 'ED Caveat' With Caution

Question: I have notes in front of me that indicate the ED physician performed a comprehensive examination and high-complexity medical decision making during an E/M service. But the patient was only sporadically conscious during the encounter, and when he was awake, he appeared to be suffering from auditory hallucinations. This made taking the history portion of the E/M virtually impossible for the physician. What E/M code should I assign for this encounter? Illinois Subscriber Answer: It may be appropriate to apply the "ED caveat" for this encounter, which would allow you to code a level-five E/M.You can exclude...

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