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Optum Lynx ED Software

Debra Posted Mon 12th of January, 2015 13:33:00 PM

Since there are no CMS official guidelines for selection of Facility E&M Levels and there are many good software applications out there to help select the correct level, I am wondering about this.

Since Facility E&M levels usually reflects the volume and intensity of resources utilized by the facility to provide patient care, if the software automatically selects an Facility E&M by the presenting problem and not the final diagnosis, is this acceptable to use triage presenting problem only.

For instance, a 25 yo male comes in for a precautionary examination only after a motor vehicle accident, no trauma, no injuries.

The physician selected MVC- as the presenting reason for visit which automatically assigns a traumatic higher level of 4 but no resources were provided, no x-rays, no meds, nothing else.

The final diagnosis is V71.4 with a Level 4 being charged out. Is it acceptable practice to use the presenting diagnosis when the final diagnosis is different.

Another example, for instance, 25 yo comes in c/o chest pain. Patient has been coughing, is a smoker, final dx is bronchitis but the Facility E&M level charged is based on triage presenting problem of chest pain which actually assigns a higher cardiac acuity level.

Is this acceptable since there are no official guidelines that the software application can do this?

Thanks,

SuperCoder Answered Wed 14th of January, 2015 02:23:58 AM

We are researching and will get back to you ASAP. Thanks !!

SuperCoder Answered Wed 14th of January, 2015 02:23:58 AM
Researching.
SuperCoder Answered Mon 19th of January, 2015 09:53:45 AM

You are right that you can just code facility E/M basis presenting problem and not taking into consideration the final diagnosis.

In addition, you should take into account the different possible interventions the facility performs to manage the ED patient.

You should discuss these facts with your software provider and ask for clarifications.

Thanks !!

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