Wiki Er 99284?

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I was told that it is very hard for ER to get level 4...but the problem is I'm seeing a lot of level 4 encounters...I keep reading it and reading it and still comes out a 4...they have detailed history, detail exam (at least 2 elements checked in 6 or more systems) and a new problem with a prescription...I'm so hesitant to give it a 4 for something simple as a back pain or URI but if it's all there...very perplexed.

Also, on the MDM and under the DX points, for ER majority of these are New problem which automatically calculates into moderate and throw in the prescription and for 2 out of 3 in MDM it meets moderate so they get 99284 for MDM. If anyone can give me any pointers it will be greatly appreciated.
 
Ed 99284

You have to use common sense. The MDM determines the level. If someone has strep and they give the patient a RX for ABX, it is low complexity. Just because the "puzzle" comes out a level 99284, the complexity of the visit would still be low. 99282

Take a look at the ED codes in the CPT book.

99281 - problems are self-limited or minor
99282 - problems are low to moderate severity
99283 - problems are moderate severity
99284 - problems are high severity and require urgent evaluation by the physician but do not pose an immediate significant threat to life or physiologic function.
99285 - problems are of high severity and pose an immediate significant threat to life or physiologic function.

So does a sore throat, even though they got a Rx for Abx a "high severity" problem.

For example: You could have a 40 year old that comes in with chest pain that turns out to be a MI. You could also have a 60 year old that comes in with chest pain and turns out to be too many chilli dogs. Which means your documentation for both cases would be a Comprehensive History and Comprehensive Exam. The MDM will decide whether it is a MI for the 40 year old and probably an admission or maybe just Observation for a rule/out MI. Where as the 60 year old could go home after getting some maloxx and a Rx for Previcid.

The bottom line the MDM drives the visit. Hope this helps.
 
i use the 3M software, and i do believe that 2 different labs are 2 different points, IF they are different types, i.e., venipuncture and arterial puncture. while they are both considered minimal, they are categorized seperately. but, the remaining MDM also needs to be considered. planning and review of diagnostic procedures should also be counted, any meds, rest, etc are also counted, as i'm sure you know.
 
It doesn't matter how many labs you order/review you only get credit for one. If you got "points" for every which way you drew blood and the 100 of panels you run ... everyone's "data" under MDM would be at it's max. It's just as easy to order a whole slew of tests as it is one. and typically when you go to the ER they automatically do a set amount labs. For example, if they are taking blood and you're female, you're getting a pregnancy test even if you didn't even go there for anything related to pregnancy. This is a standard/precaution.

I agree MDM drives the visit, but don't forget the documentation for the history and exam need to support that level as well.
 
Determining MDM

While you DO need 3 of 3 key components to determine the level of ER visit (History, Exam and MDM) ... When you are determining the level of MDM you only need 2 of the 3 areas (problem points, data points, risk)

So, for example, let's say you have 3 problem points, only 1 data point, and moderate risk. This would still give you moderate level of MDM, based on problem points and risk.

Most of the time you will be looking at problem points and risk to determine your level of MDM.

Hope that helps.

F Tessa Bartels, CPC, CEMC
 
I code for ED visits and we rarely use 99282...this would be for a visit that the physician only breifly seen the pt and very low complex problems like poison ivy.... usually you only see the nurse for this level, things like return for suture removal, redress of a wound (within the global time frame). Lacerations would be a level 3. You do need to count points sometimes but you can climb to a level 4 or 5 very quickly. I also realize every provider determines how the level will be coded to some extent, within the law of course. My hat's off to all ED personnel, I would not want to do what they do every day.
 
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