Wiki E&M coding for Overdoses in the Urgent Care setting

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chrissyr

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Hello,
Does anyone have any experience coding for overdoses in their practices? I work for an urgent Care group and unfortunately we are seeing a rise in patients being dropped off at our facilities, unresponsive due to OD. We stabilize and send to the ER. Although stabilizing typically includes administering Narcan and CPR, sometimes the E&M level is minimal due to the lack of documentation. My providers have a big problem with a low level E&M due to the sheer severity of the situation/condition. We are working with our providers to get better documentation. But I just wanted to get a general idea of how others code for this.
Thanks!
 
Any time a provider sees a patient, even just stabilizing, they are doing an exam. Just get them to document what they're observing, and a statement that they cannot obtain further history due to the patient's altered mental status, and you have a billable service. A statement of why a history is unobtainable is sufficient for a comprehensive history.
 
In a situation like this, it may be more effective to bill based on time - certainly stabilizing the patient and arranging transfer to a hospital would fall into the category of 'coordinating care' for billing an E&M code based on time instead of history and exam. If the providers are spending more than 30 minutes with one particular patient, I'd recommend considering billing critical care codes, 99291-99292 - certainly if a patient is unresponsive due to an overdose, this meets the medical necessity criteria to support it.
 
We always have a billable service as documentation is there. The issue is that providers want to charge 99205/99215 due to the severity of the condition, but often times they do not have the documentation to support it. So for example, an 05 needs comp hpi , comp exam, and high mdm. We can usually manage to get a comp hpi by documenting that history is unable to be obtained and a comp exam is pretty attainable because we use 95 guidelines. However, even though the patient is critically ill, we typically only get a moderate mdm. It is a new problem to the provider with no additional workup planned (as sending to the ER is really transfer of care), we usually have 0 data points, and high level of risk. That equates to a moderate mdm. So we could only bill an 04. If patient was established, we could bill a 15.
But really what I am wanting to know is what other people are billing for this service and what does their documentation look like? Are they able to get to a high mdm? And if so, how?

Critical care is not an option for us as we never spend 30 minutes with a patient we are stabilizing and sending out. They are usually out of our office within 10 minutes.
So time based coding is also not any help (in relation to my problem). My providers feel that this service/risk supports billing higher levels. Coding based on time would only get them 99212 at best.

Thanks for the replies so far. I appreciate it.
 
I see how they are thinking, but, unfortunately, the patient's condition is not the only thing that an E/M is based on.

Can't you bill for the Narcan administration and performing the CPR?
 
CatchTheWind said:
I see how they are thinking, but, unfortunately, the patient's condition is not the only thing that an E/M is based on.

Can't you bill for the Narcan administration and performing the CPR?
Click to expand...

I agree with you. I have coded for a long time. I am use to dealing with providers and am pretty good at making them understand the rules. Unfortunately, this opioid crisis is getting so incredibly bad that providers do not want to hear that a near-death patient only warrants X level. They want the highest level. I totally get it. But I can't change the rules.
I really like this forum though. It is nice to be able to talk with other folks to get their view point (i.e. Am I over looking something? Am I interpreting the guidelines differently, etc.)

And yes, we are able to charge for Narcan and CPR.
 
Any suggestions on urgent care coding help/ resources?

I recently got a position as an Urgent Care coder for an urgent clinic (haven't started yet). I only have done orthopedic surgery coding previously and have been out of the game for about a year (due to moves and kids). I was wondering if anyone can provide any good resources they have used to help me make the transition to urgent care? I saw that there is a webinar I can purchase, but I am not seeing a whole lot of anything else. I think it will be mostly occupational health (flu shots, physicals, drug tests, etc) but want to try to get ahead of anything that may pop up that's incredibly different. I'm not used to doing a whole lot of E/M Coding so I know I need to brush up on that for sure. Any information would be greatly appreciated! I'm Hoping to make sure I'm up to date on things as much as possible.
 
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