Outpatient Facility Coding Alert - 2018 Issue 2
Reader Question: Base ED E/M Code on Problem and Work, Not Final Dx
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Article Overview
This reader Q&A discusses emergency department evaluation and management coding for a case involving chest pain and a complex workup that ends with a non-cardiac final diagnosis. It is aimed at coders, auditors, and billing staff who review ED E/M leveling and medical necessity, and it focuses on general coding considerations for assigning the appropriate level of service in the ED.
Why This Topic Matters
ED E/M leveling can be difficult when the final diagnosis differs from the initial presenting complaint. The article highlights why review of the presenting problem and overall work is important for accurate code selection and documentation review.
What You Will Learn
- How emergency department E/M coding is framed in a reader question-and-answer format.
- Why the presenting problem is relevant to ED visit leveling.
- How work performed during the encounter factors into coding review.
- Why final diagnosis alone may not reflect the complexity of an ED visit.
- How medical necessity relates to ED E/M code selection.
Who Should Read This
- Medical coders
- Coding auditors
- Emergency department billing staff
- Compliance reviewers
- Practice managers
Codes Discussed
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