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ED Coding and Reimbursement Alert

You Be the Coder:

Don't Discount The MDM When the NOPP Is High

Published on Sun Jul 15, 2012

Question: A 20 year-old patient presents to the ED with a fever of 105, weakness and body aches. He went to his regular physician yesterday who had prescribed an antibiotic. The documentation seems to only warrant a level two E/M code (99282), but I don't feel this is sufficient for the situation. The problem is the documentation shows a detailed history and detailed exam but the only treatment done in the ED is lab work. The physician gives no medication to the patient during the ED encounter, nor does he send him home with any. Should we report this case as a 99282 because of this low medical decision-making?Tennessee SubscriberAnswer: This patient sounds like he has a higher nature of the presenting problem (NOPP) than is warranted by a 99282 (Emergency department visit for the evaluation and management of a patient, which requires these 3 key components: an expanded problem [...]
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