queeniek
Contributor
Moderate MDM in the ED can be 99283 or 99284. I'm looking for guidance on how to determine which is the appropriate level.
I understand that portion, I'm curious about those that have a detailed or comprehensive history and exam. When it truly comes down to MDM, how to do you decide what is low/moderate vs moderate/high? For example:The level is assigned based on history and exam in addition to MDM. Although both codes require the same moderate level of MDM, 99284 also requires a detailed history and exam, whereas 99283 requires only an expanded history and exam.
I understand that portion, I'm curious about those that have a detailed or comprehensive history and exam. When it truly comes down to MDM, how to do you decide what is low/moderate vs moderate/high? For example:
3 points for # of Dx and/or treatment options (new patient with no workup)
2 points for amount and/or complexity of data (history from mother)
Prescription for Zofran
Final Impression: Patient well appearing and in no distress. Gastroenteritis
99283 or 99284?
One thing you may look at is whether there should have been a diagnosis of dehydration since Zofran is used in viral gastroenteritis when the child is moderately to severely dehydrated or cannot tolerate oral rehydration with electrolyte solutions (e.g., Pedialyte). Moderate to severe dehydration in a small child increases risk of hospitalization. This may not be the case here (unless the child improved significantly during the visit) since the final impression is well-appearing and in no distress. However, it is important to consider manifestations that increase the complexity of the visit.I understand that portion, I'm curious about those that have a detailed or comprehensive history and exam. When it truly comes down to MDM, how to do you decide what is low/moderate vs moderate/high? For example:
3 points for # of Dx and/or treatment options (new patient with no workup)
2 points for amount and/or complexity of data (history from mother)
Prescription for Zofran
Final Impression: Patient well appearing and in no distress. Gastroenteritis
99283 or 99284?