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

Article Overview

This article discusses a UnitedHealthcare emergency department evaluation and management policy and why its interpretation of medical decision making has drawn attention from coders and emergency medicine practices. It explains the general issue, references Medicare and CPT guidance for comparison, and describes the kind of payer communication and appeal considerations that may arise when claims are challenged. The piece is most relevant to emergency department coders, billers, and reimbursement staff who handle payer-specific E/M review policies.