Wiki level 4 or 5 according to 2021 guidelines?

wynonna

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Patient is in ER and is admitted and discharged next day. We did not do admission, we did ER consult on Day of Admission and did not see patient on Day of discharge.
CT scans were personally reviewed by ENT-our practice. Hospital admitted.
How is this scored? We normally bill office visits under Observation for admissions less than 72 hours, so this would be 99204 or 99205.
Patient's insurance does not cover Consults (Blue cross)
Per 2021 guidelines, would this score a level 99205 because a "decision regarding hospitalization" was made under "high risk" AND
"independent interpretation" of test performed by another MD or qualified health professional?
Or would this be 99204 for Rx management (augmentin continued) and personal review of CT?
Patient's only complaint is Acute parotiditis.
Would you score a level 4 or 5?
thank you
 
Where did you end up? Problem? Data? Risk/Patient Management? Doesn't sound like you had enough to warrant a level five. You need two of three elements to support a level... Make sure you read the guidelines, especially with regard to data. Guidelines were updated March 9, 2021.
 

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  • 2021 EM GUIDELINES - UPDATED MARCH 9 2021 - EFF JAN 1 2021.pdf
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Right. I see now that I NEED 2 OUT OF 3 CATEGORIES IN "Amount and/or complexity of data to review and analyze", not just ONE as in the case of level 4.
Thank you my fellow coders. You answered my question. It will be 99204.
Cheers!
 
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