Common Documentation E/M Down Codes for Medicare records

 HPI-need 4 HPI elements for 99285 need 4 HPI elements for 99285 

 With 3 or less go down to 99283 With 3 or less go down to 99283 

 ROS-need 10 ROS for level 99285 need 10 ROS for level 99285 

 If 2-10 go down to 99284 10 go down to 99284 99285 

 Physical Exam-need 8 systems for 99285 

 If <8 go down to 99284 

 Past/Family/Social Past/Family/Social- need 2 for 99285 need 2 for 99285 

 If just one go down to 99284

99285 Acuity Caveat

 99285 ED visit for the evaluation and management of a patient, which requires these three key components three key components within the constraints within the constraints imposed by the urgency of the patient imposed imposed by the urgency urgency of the patient s patient s' clinical clinical clinical condition and/or mental status 

 Severe Dyspnea Dyspnea - COPD, Asthma Pneumonia COPD, Asthma Pneumonia 

 Unstable Vital Signs Unstable Vital Signs- Trauma, Sepsis Trauma, Sepsis 

 Severe Pain - Long bone fractures open 45 

 Severe Pain - Long bone fractures fractures, open fractures 

 CPR/intubated intubated 

 Should state on chart: Hx/Exam limited by____

Critical Care Overview

 Unlike other E/M codes no specific key Unlike other E/M codes no specific specific key element requirements 

 History, Physical Exam, Medical Decision Making 

 No Specific HPI, ROS, Physical Exam  documentation requirements 

 Time based code 

 Patient must meet certain clinical criteria

Critical Care Definition

“A critical illness or injury acutely impairs one or more vital organ systems such that there is a high probability of imminent or life threatening deterioration in the patient's condition..”  (AMA/CPT 2008)