tci E/M Coding Alert - 2022 Issue Q2

Reader Questions: Stick to Documentation When Reporting Encounters Related to COVID-19

Question: Our emergency department (ED) sees a lot of patients with multiple comorbidities, and many of these patients have presented with COVID-19. Can we bill for a higher-level E/M service to reflect these more complicated encounters? Rhode Island Subscriber Answer: As with any ED evaluation and management (E/M) service, you’ll establish the level of service based on the history, exam, and medical decision making (MDM). The trick is to not get distracted by outside knowledge of complications and comorbidities. Stick to what’s documented. That’s not to say comorbidities won’t ever move a COVID-19 E/M encounter...

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