E&m - Overarching Criterion, Phy Er

[MANNLM]

I have been sending some E&M services for audit and got some dings related to "Medicare overarching criterion". Was wondering how many coders are using this and I understand basically when there is one diagnosis, but when you get multiple diagnoses I get lost. Would appreciate any comments.

[rthames052006]

Originally Posted by MANNLM

I have been sending some E&M services for audit and got some dings related to "Medicare overarching criterion". Was wondering how many coders are using this and I understand basically when there is one diagnosis, but when you get multiple diagnoses I get lost. Would appreciate any comments.

I do factor in the ovearching criterion you just kinda know when to... I had a physician who would always bill a level 4 visit for bronchitis in an otherwise healthly young pt with no co-morbidities...

it would be differant if the patient was perhaps asthmatic, had copd some type of respiratory ailment...

Now if it was a Medicare pt w/ copd, asthma it would be a differant story, there are underlying factors you must think about when there are other ailments/ conditions going on.

Just my thoughts,

Roxanne Thames, CPC