# Psychiatric visits in the Emergency Dept



## ptrautner (Nov 13, 2008)

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..


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## kevbshields (Nov 13, 2008)

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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## ptrautner (Nov 13, 2008)

Thanks for all your help Kevin...

Yes, we do use the ACEP, our consultant is equally confused.


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