Just because a pt is kept in the ED overnite or several hours does not make it anything more than an ER encounter. There must be a physician order to admit to inpatient or admit to outpatient to use anything other than ER levels. Then only the attending physician may bill for the discharge either inpatient or observation. If no order was written and the poatient staus never changed then the "discharge from ER" is part of the MDM for the ER visit level
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