ER Physician EM Levels in the ER

nancyoro

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I code for ER Docs. We have a new supersvisor that has given us directions that if a patient comes into the ER and receives a IM, that would make it a 99284.

For instance I had a chart, patient came CC toothache DX Dental carries received a IM of Tordal.
I do not agree that would be a 99284 when reading the description of 99284. My previous supervisor directed us to bill a 99283.

Would like some feedback please
 

renie

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IM in the ER

I code E/M levels for the facility side of the ER. I agree that a level 4 is definitely too high for a IM of Toradol. We would make it a level 2 or 3 for the facility. Level 2 if the IM is the only treatment for the patient. Our levels are from a grid and the intensity of care and resourses used so our method of determining the level is different but I still agree with your interpretation of Level 4 for the physician.
 

mitchellde

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I code for ER Docs. We have a new supersvisor that has given us directions that if a patient comes into the ER and receives a IM, that would make it a 99284.

For instance I had a chart, patient came CC toothache DX Dental carries received a IM of Tordal.
I do not agree that would be a 99284 when reading the description of 99284. My previous supervisor directed us to bill a 99283.

Would like some feedback please
You cannot make any determinations of the visit level on the physician side based on what was ordered. The physician level is based on the documentation provided by the physician and application of the 95/97 guidelines. The injection would not even be charged by the ED physician as that is the facility's charge. I have looked at some ED documentation that could support a level 4 and no injections were ordered and some with multiple injections that could not begin to support even a level 3. If you are not reading the documentation and applying the physician guidelines than you should not be assigning the level of care for that physician.
 

nancyoro

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I do not make determinations by what was ordered, but by reading the documentation., and i know the injection is charged by the facility side, as i also code for facility. This was a simple chart nothing special in pmh or hpi etc.. Just complained of tooth pain and was dx dental caries 1 im of toradaol and go home. I've told my supervisor i disagee with her that this should be a 99284, but her response was show me other documentation that proves otherwise.
 

mitchellde

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the fact that the 3 key components do not support the 99284 is not sufficient? if there is nothing more tan what you have indicated here it looks like a 99281.
 
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