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#Vital decisions blue cross blue shield code
#Vital decisions blue cross blue shield professional

Head injury with brief loss of conscience & Glasgow Coma Score 13-15.Headache (w/advanced imaging, >1 treatment, admission).The presented problem(s) are of high severity and require urgent evaluation by the physician but do not pose an immediate significant threat to life or physiologic function. Localized infection requiring intravenous (IV) antibiotics & discharge (kidney infection).Gastrointestinal (GI) bleed, fissure, hemorrhoid.Mental health (anxiety, simple treatment).Eye pain (corneal abrasion or infection, blepharitis, iritis).Minor trauma requiring imaging or medical procedures (Level 3 or lower triage score).Abdominal pain w/o advanced imaging (simple viral gastroenteritis w/fluids).Head injury (w/o neurological symptoms).Headache (resolves after initial treatment).The presented problem(s) are of moderate severity.Įxamples: Head injury instructions, crutch training, bending, lifting, weight-bearing limitations, prescription medication with review of side effects and potential adverse reactions patient may have questions, but otherwise demonstrates adequate understanding of instructions either verbally or by demonstration. Moderate complexity medical decision making.Ear pain (otitis media, sinusitis, vertigo, swimmer’s ear, Temporomandibular Joint (TMJ) Dysfunction).The presented problem(s) are of low to moderate severity.Įxamples: Over the counter (OTC) medications or treatment, simple dressing changes or patient demonstrates understanding quickly and easily. The presented problem(s) are typically self-limited or minor conditions with no medications or home treatment required.Įxample: Signs and symptoms of wound infection explained, return to ED if problems develop. Straightforward medical decision making.

#Vital decisions blue cross blue shield code

The tables below provide criteria that Blue Cross Blue Shield of North Dakota (BCBSND) will use to determine the appropriate code application for ED services. If a denial is appealed, the supporting documentation must be included in the appeal request. The documentation must clearly identify, and support ED E/M codes billed. Medical records and documentation may be requested from the provider to support the level of care rendered. Facility codes reflects volume and intensity of resources used by the facility to provide care.

#Vital decisions blue cross blue shield professional

Professional codes are based on complexity, performed work, which includes the “cognitive” effort. The level of service billed must be based on the intervention(s) that are performed in relationship to the medical care required by the presenting symptoms and resulting in diagnosis of the patient.

Revenue Code: 0450 – Emergency Room – General.

Place of Service (POS): 23 – Professional claims ED visit E/M codes are restricted to the emergency POS.

Note: Per the American Medical Association (AMA), time is not a descriptive component for the emergency department levels of E/M services because emergency department services are typically provided on a variable intensity basis, often involving multiple encounters with several patients over an extended period of time. The ED codes require the level of Medical Decision Making (MDM) to be met and documented for the level of service selected. There are 5 levels of emergency department services represented by CPT codes 99281 – 99285. Coding & Billing GuidelinesĮmergency Department (ED) Evaluation and Management (E/M) codes are typically reported per day and do not differentiate between new or established patients. This document provides coding and billing guidelines for Emergency Department Providers (facilities and physicians or other qualified health care professionals (QHPs)) to ensure the code(s) billed meet the coding requirements.