tci ED Coding & Reimbursement Alert - 2020 Issue Q1

Reader Question: How to Proceed When Coder, Physician Disagree

Question: Our physician recently coded a critical care service using the time spent with the patient to select the code. However, our coding team reviewed the medical record, and 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 with 99285 instead. Any suggestions as to whether we can, or should, code for a different service than the physician chose to perform? Wyoming Subscriber Answer: If you believe you have a strong reason to question the necessity or length of the critical...

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