Coding Corner: Dazed and Confused

An 84-year-old woman with a history of dementia was admitted for worsening confusion over the last two days. Her initial workup in the emergency department is unremarkable including a normal urinalysis, basic metabolic panel, complete blood count, and CT of the head. On day two, she is increasingly combative and requires restraints. After a discussion with her family about the risks and benefits, quetiapine is added nightly. You order an electrocardiogram to check the patient’s QT interval, magnesium level, and another basic metabolic panel. On day three, she continues to require intermittent restraints along with the addition of haloperidol as needed. What level of billing does this qualify for? This would qualify for level 3 (99233). This patient’s ongoing encephalopathy can be documented as an acute threat to life due to her inability to maintain her activities of daily living and personal safety. Alternatively, it could be documented as a severe exacerbation of a chronic disease (dementia) requiring ongoing inpatient care. If her level of confusion is significant enough to justify restraints, then it should be documented that she remains a threat to herself or others. Restraints are treatments with a high risk of morbidity due to the risk of increased delirium, self-injury, loss of patient autonomy, electrolyte disturbances, and rhabdomyolysis, which is why they are generally used as a last resort. The use of chemical restraints, such as quetiapine or haloperidol, wou...
Source: The Hospitalist - Category: Hospital Management Authors: Tags: Business of Medicine Clinical Guidelines Source Type: research