I work in an Urgent Care and we are having some trouble with the E/M code for emergency situations when patients are transported by squad to the ER. In these emergency situations we are only coming up with a 99214 level E/M for established patients but it seems that these should be a higher level of 99215. One of our coders read that anytime a patient is transported by squad that their histroy level automatically becomes a high. Does anyone know if this is true?
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Wiki Figuring an E/M for an Emergency
- Thread starter AHESLER
- Start date
I work in a Community Health Center and we do see walk in patients (but we are not Urgent Care). We have the same situtation, patients being transported to the ER via rescue. In the past (before my time), there have been consultants who have told our providers that if a patient goes by rescue that the visit is 'automatically' a 99215. I have not seen anything in writing to support that. I have been telling my providers that while the patient's condition likely warrants a 99215, the documentation still must support it, whether by time override or HPI/exam/MDM. I would like to be wrong on this, as it is not unusual to send 1 to 2 by rescue every day, more in the summer (our peak season).
MnTwins29
True Blue
Wonder if your guidance was because the MDM will most likely be high (new problem with workup for 4 pts in diagnoses and High risk)? You are right, it would depend on documentation of the Hx or exam - can't automatically assume 99215 just because of the mode of transportation.