tci ED Coding & Reimbursement Alert - 2020 Issue Q4

E/M Coding: Understand What “Additional Workup Planned” Means to This Payer

Getting to know UHC’s definition can help you calculate MDM. According to CMS data, about half of ED claims are reported with code 99285 (Emergency department visit for the evaluation and management of a patient...), but that number could be dramatically different for one payer, due to a unilateral interpretation of a medical decision making (MDM) rule that has been causing confusion for quite a while now. Background: UnitedHealthcare (UHC) has decided to try and make it more challenging to report ED code 99285. For the past two years, UHC’s coding policy has attempted to advance...

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