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Posted By jan on 10-04-2001, 16:20:00 in Emergency Department
I am opening myself up to alot of "is she nuts " comments, but I
really need some input, so be gentle but any help is welcome.
If our ERMD does the CS for another MD, most often an orth MD, ( I'm
not coding CS for our MD. I am also not coding anesthesia codes. I have
been down that road and beleive me bottom line among other reasons,is
anesthesia has exclusive contract in hospital to charge for anesthesia
services. So we will rule that out, as an option.
Senerio, child breaks distal radius , it needs reduction. ERMD
evaluates pt, does xray, sees break,(no I can't code for xray interp
either ,anothe exclusive contract) says to MOM and pt it's broken, then
consults family MD or ortho on call and the ortho MD comes in and does a
reduction. The ERMD documents 4 HPI, 10 ROS, 2 PFSH, 8 exam elements,
plus the ASA level risk and benefits, at bedside for 20min while under
deep sedation, conscious sedation protocols for our hospital followed,
pt was given IV sedation with whatever it took, IV, pt status post
sedation and finishes chart with outcome of reduction, discharged with
instructions per ortho, and really wonderful documentation everything that
you could think of is covered in this documentation.
I am having difficulty in justifying the Level 5 because the injury is
not life threatening, and is repaired by another MD. granted there is
consultation involved, but where does the giving the IV med( or having
the RN give the med and he supervises, right there,) and supervising
conscious sedation fit to a Level 5.Or does it??
Can just a procedure justify a higher level just because it is
complex.?? See where I'm having difficulty?
Anyone want to bail me out of this dilema???
Truth is I want to code a level 4, not 5. HELP