Wiki 99285 MDM-High

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Captain74

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I have a physician in the ED that bills many of his abdominal pains as 99285 and I am just not sure that can be justified.

He does have a Comprehensive History and Exam, but when it comes to Medical Decision Making we are not seeing eye to eye. He believes that the MDM is determined based on the need to eliminate possible conditions (appendicitis, PID, etc) in order to get to a diagnosis. Because of this, he feels HIGH Medical Decision making is justified as there is a potential that one of those reasons for abdominal pain "could" have been life threatening even thought it is eliminated.

I understand that if you have a patient with abdominal pain requiring additional workup and an IV with pain meds is given that that would justify the a HIGH Medical Deicison Making, but if you no IV with pain meds is given can it really be HIGH?

Personally I don't think the majority of abdominal pains are 99285, but I sure could use some opinions on this. If you have hard evidence either way, please send it my way.

Thanks

Cory
 
Hi,

I would completely agree with you, not all abdominal pain would qualify for 99285. I would look for the following parameters to move to Higher risk:

1. Severe Pain
2. Any abdominal /Pelvic ultrasound taken
3. Abnormal vitals
4. Patient admitted or transferred
5. EKG or cardiac workup done to rule out any cardiac disorders
6. Severe Dehydration or hemetemesis
7. comprehensive work up

Hope this helps you....
Have a great day! Happy New Year 2013!

Purnima S
 
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