ED Coding and Reimbursement Alert

Beware: This ED exception has strict documentation requirements.A patient reports to the ED with a severe illness or injury. Encounter notes indicate that the physician provided a comprehensive exam and high-level medical decision making (MDM) ... but the history documentation is limited.What do you do? The level five ED acuity caveat, a very specific coding exception, could help you code this service as a 99285 " provided the encounter notes reflect a level-five exam and MDM.Before using the ED caveat, however, you need to know when you can " and can't " invoke this inception. If you employ the ED caveat improperly, auditors are likely to come beating at your door.Use these ED caveat do's and don'ts to guide your ED exception coding.Do Look to Caveat When History's UnobtainableIn basic terms, the ED caveat allows providers to document the history that is reasonably obtainable from a severely ill patient while [...]