ED Coding and Reimbursement Alert

Question: Our practice uses a template that includes a check box designated -All other systems negative.- If the physician marks this box, does that indicate to the insurer that he specifically inquired about all systems? Or is it appropriate for him to mark it if he simply asked the patient, -Is anything else bothering you?- and the patient replied, -No-?


Ohio Subscriber

Answer: Under audit, the examiner will assume that the physician has asked about at least 10 systems. He may also ask the group directly. If the answer is anything but yes, the examiner will disallow the statement on all charts.

Here's the deal: After the examiner disallows the statement, he will only count the clearly documented review-of-systems elements. For example, because 99284 (Emergency department visit for the evaluation and management of a patient, which requires these three key components: a detailed history, a detailed examination, and medical decision-making of moderate complexity) requires review of two to nine systems, you-ll find after the examiner's audit that most level fives will receive downcoding to level four.
 
This could have serious implications for your practice, so your best bet is to play it safe and instruct physicians to check the -all others negative- box only if they specifically ask the patient about each of those systems.

Reader Questions and You Be the Coder reviewed by Michael A. Granovsky, MD, CPC, FACEP, vice president of Medical Reimbursement Systems Inc., an ED billing and coding company in Stoneham, Mass.