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looking for Decision Tree or Algorithm

  1. Default looking for Decision Tree or Algorithm
    Medical Coding Books
    Does anyone have a Decision Tree or any type of Algorithm for Hospital E&M coding. Like for Inpatient, Observation, ER. When to use the office Consults versus the Hospital Consults.

  2. #2
    Columbia, MO
    the type of patient ie inpatient, outpatient, ER, Office, will determine your POS which in turn will determine what type of E&M code you select. Er is POS 23 and you use ER visit levels, Inpatient is 21 and you use Inpatient visit levels, Observation is 22 and you use either the observation admit and discharge or office levels. As far as consults go it now depends on who the payer is, If Medicare is involved then there is so no such thing as a consult anymore, and you have to aware of the other carriers that have adopted Medicare's policy on consults. I am not sure if this addresses your issue or not.

    Debra A. Mitchell, MSPH, CPC-H

  3. #3
    Daytona Beach, FL
    EM University has an Algorithm for Consults which is helpful in trying to determine which code to use. Hopefully this will help you.
    Jodi Dibble, CPC

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