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ED Coding and Reimbursement Alert

Readers Question:

High MDM Highlights Caveat Claims

Published on Wed Jan 27, 2010

Question: A patient from a nearby nursing home reports to the ED with a low-grade fever. The patient is chronically demented with bouts of delusion, and unable to provide any information on her own; the patient's caretaker cannot help the patient communicate with the physician either. The physician orders urine tests after an expanded problem focused exam. Test results point to a urinary tract infection (UTI), which the physician diagnoses; the patient is then discharged with a prescription for antibiotics. Can I apply the ED acuity caveat for this scenario? Tennessee Subscriber Answer: This is not an ED acuity caveat situation. On the claim, report the following: • 99283 (Emergency department visit for the evaluation and management of a patient, which requires these 3 key components: an expanded problem focused history; an expanded problem focused examination; and medical decision making of moderate complexity ...) for the E/M; • 599.0 (Urinary [...]
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