tci ED Coding & Reimbursement Alert - 2004 Issue 10

Reader Questions: Back Up Use of MDM for 99285 Caveat

Question: Is there such thing as an acuity caveat for medical decision-making (MDM)? A patient presented with three seizures that day for unknown reasons and left against medical advice to drive himself home. We had an auditor "caveat" this case to a level five. Is this correct?          Colorado Subscriber Answer: While no specific acuity caveat exists for MDM, the Medicare documentation guidelines do state that the physician's documentation should reflect why the doctor couldn't obtain a complete history. Logically, these guidelines would then allow for an incomplete history if there...

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