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tci ED Coding & Reimbursement Alert - 2005 Issue 3

READER QUESTIONS: Assign E/M Code for Nonspecific Care

Question: The physician diagnosed a patient with a second-degree burn on her right palm (944.25). He advised the patient to apply ice or run cold water over the area two or three times a day, but no specific care was given in the ED. In the documentation, he noted that blisters had formed over the base of the right thumb and palm that measured about 6 cm in diameter. How should I report this encounter?Georgia Subscriber Answer: Because the physician only evaluated the patient's problem and provided a treatment plan, you should report the appropriate emergency department...

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