tci ED Coding & Reimbursement Alert - 2010 Issue 1

Readers Question: High MDM Highlights Caveat Claims

Question: A patient from a nearby nursing home reports to the ED with a low-grade fever. The patient is chronically demented with bouts of delusion, and unable to provide any information on her own; the patient's caretaker cannot help the patient communicate with the physician either. The physician orders urine tests after an expanded problem focused exam. Test results point to a urinary tract infection (UTI), which the physician diagnoses; the patient is then discharged with a prescription for antibiotics. Can I apply the ED acuity caveat for this scenario? Tennessee Subscriber Answer: This is not an ED acuity...

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