tci ED Coding & Reimbursement Alert - 2005 Issue 1

Reader Questions: Navigate Caveat Rules Carefully

Question: I am confused about the proper use of the acuity caveat. I understood that we can only use it to invoke a level-five E/M, but I've recently heard that we can use it for other E/M codes, such as 99283. Is this correct usage?       Kansas Subscriber Answer: The most direct answer to your question is that the acuity caveat in the description of code 99285 (Emergency department visit for the evaluation and management of a patient, which requires these three key components within the constraints imposed by the urgency of the patient's...

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