ED Coding and Reimbursement Alert

-  but ask payers before deciding on E/M level

While there is no answer key for exactly what constitutes a level-one, -two or -three subsequent hospital care service, you might consider this chart when deciding on E/M levels, says Michael A. Granovsky, MD, CPC, FACEP, vice president of MRSI, an ED billing company in Stoneham, Mass.:
  
If the patient is stable, recovering or improving, this is likely a 99231 service (Subsequent hospital care, per day, for the evaluation and management of a patient, which requires at least two of these three key components: a problem-focused interval history; a problem-focused examination; medical decision-making that is straightforward or of low complexity).
  
If the patient is responding inadequately to therapy or has developed a minor complication, you-ll use 99232 (... an expanded problem-focused interval history; an expanded problem-focused examination; medical decision-making of moderate complexity) to report these types of scenarios.
  
If the patient is unstable or has developed a significant complication/new problem, these issues typically warrant 99233 (... a detailed interval history; a detailed examination; and medical decision-making of high complexity).
  
Caveat: These are not hard and fast rules, merely guidelines to steer you toward the proper subsequent hospital care code. 
  
No matter what service level you choose, be sure your documentation proves medical necessity and explains clearly what the physician did during the subsequent hospital care encounter.