Psychiatric visits in the Emergency Dept

ptrautner

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Hartford, CT
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As far as E/M levels go... What is the standard that should be given? I typically give a 99285 for nursing, the patient is having 15 minute checks, for example has a multitude of issues from alcohol intoxication, drug abuse, paranoid schizophrenia, is violent etc... I guess it would depend on policy, but i know that the nurses are earning their 5 . On the professional end..i give the doc a 4 if he is just doing a med clearance and patient is going to crisis unless the patient has more med issues besides the alcohol or psych illness i would give him a 5 depending on documentation. I have heard the thinking is if the doc discharges patient and he kills someone we are liable so there is a higher risk involved with caring for these types of patients.. For those who code these types of records i was wondering on what is typically given in these cases? Guarded against overcharging on these records..
 

kevbshields

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Louisville, KY
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For professional fee, I score out the E/M. As to whether these patients are "high risk," that would need to fit the definitions provided by the Table of Risk and be justifiable.

For the facility fee, I'd really take a look at what criteria you're using to establish the ER code. Are you using the ACEP standards or what? There isn't a lot of standardization from hospital to hospital in that area. Heck, I've even seen variances from coder to coder. Regardless, here's the website to those standards; at least it's something recognized! http://www.acep.org/practres.aspx?id=30428

Good luck to you.
 
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