tci ED Coding & Reimbursement Alert - 2003 Issue 3

Reader Question: Resolve Coding Disagreement with Physicians

Question: We disagree with our emergency physician's documented level of care for one of his critical care patients. The physician documented critical-care-time minutes, but upon review of the medical record, we don't think the patient's condition warrants this level of care or meets the requirements for administering critical care. We want to code the report as a level-five ED E/M service. Any suggestions as to whether we can, or should, code for a different service than the physician reported? Pennsylvania Subscriber  Answer: If you question the necessity or length of the critical care time your physician provided, you should...

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