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Thread: Caveat and Exam????

  1. #1

    Question Caveat and Exam????

    AAPC: Back to School
    If the pt is critical/unresponsive and there is not enough time for critical care I would use the caveat. But does it apply to the exam? I never thought it did, but I have something here from the American College of Emergency Physicians saying it does right at the end of the description of the caveat...

    "The level 5 caveat- the definition of 99285 includes the concept that the History, Exam, and MDM requirements must be met "within the constraints impose the urgency of the pt's clinical condition and/or mental status". Most Medicare carriers require a description of the pt's urgent condition and the physician's thought process. So make sure to document why the severity of your pts illness precludes performing a full History or EXAM."

  2. #2


    See ACEP website. The caveat does not include the exam. The physician can still perform a physical exam because they can physically see and examine the patient. The history is difficult because the patient is not in the condition to answer the questions.

  3. #3


    I completely agree, but i did quote the acep website where it included exam in the level 5 caveat. maybe they missed this and it is incorrect information

  4. #4


    Yes, I see where they are getting this. Sorry, I did so much reading on CC for my own stuff, I must have read this somewhere else. I'll look for it tomorrow and let you know the resource.


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