tci ED Coding & Reimbursement Alert - 2017 Issue 7

E/M Coding: Is UHC's New Policy Negatively Impacting ED Physicians?

"Additional workup planned" may not count in this coverage decision. Every emergency department regularly reports code 99285 (Emergency department visit for the evaluation and management of a patient...), but one payer appears to have made that a little bit more complicated. Here's why: Earlier this year, United Healthcare (UHC) updated its evaluation and management (E/M) coding policy, clarifying the number of points that can be counted toward diagnoses and management options when calculating the medical decision-making portion of an E/M code in the emergency department. The policy now says, "A provider receives three points for 'New Problem, No...

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