ED Coding and Reimbursement Alert

Question: Can the acuity caveat apply to the patient's history of present illness (HPI)? We had a patient come in with severe dementia, and the physician was unable to obtain the review of systems due to the dementia.
      
Missouri Subscriber Answer: According to 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 clinical condition and/or mental status: a comprehensive history, a comprehensive examination, and medical decision-making of high complexity), you can apply the acuity caveat to any or all of the history elements and to the exam.
 
According to the 1995 E/M documentation guidelines, "If the physician is unable to obtain a history from the patient or other source, the record should describe the patient's condition or other circumstance which precludes obtaining a history." This rule also applies to the HPI elements, so just make sure the physician documented as much as possible.