The reason the patient came to the ED is generally coded first. If the patient came to the ED primarily because they were vomiting; and the ED doc determined that it was a symptom of a URI, the more emergent diagnosis would be acceptable since the ED physican had to respond to that complaintwith at least moderate MDM to determine what the cause was. For a 4 I would be looking for some intervention; IV fluids, labs, X-Ray, meds. If none of this was done it would probably be a 3.
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