tci ED Coding & Reimbursement Alert - 2015 Issue 7

Reader Questions: Resolve Coding Disagreement with Physician

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 E/M service. Any suggestions as to whether we can, or should, code for a different service than the physician chose to perform? Answer:  If you have good cause to question the necessity or...

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