Dan Magdziarz, DO

Emergency Physician - 20 years+ … Interests include Quality - Clinical Best Practices, Medical Legal, Reimbursement … & most recently - Rural EM, 24 hr shifts!

[Dan Magdziarz, DO @EMReimbursement]

@EMNews @TayBurkholder Methemoglobinemia ... Phenacetin in Cocaine (?)

[Dan Magdziarz, DO @EMReimbursement]

@DrRazi4 @ecgandrhythmRoe awesome pick-up!

[Dan Magdziarz, DO @EMReimbursement]

@ecgandrhythmRoe WPW - Delta wave seen + short PR interval (close enough to raise caution (PR < 120 milisec) ... avoid AV nodal blockers (adenosine, Ca & Beta-blockers) ... consider IV procainamide, sync. cardioversion ( if unstable), and EP consult :)

[Dan Magdziarz, DO @EMReimbursement]

@EMBoardBombs AND INFERIOR CANTHOLYSIS - Don't stop at just Lateral Canthotomy ... Must cut (w iris scissors) inferior crus of the lateral canthal tendon (and maybe even superior crus) ... Must do both!

[Dan Magdziarz, DO @EMReimbursement]

Hi my Twitter friends & family,

It's Chicago Marathon 2023 time, again! => This year I'm fundraising for By The Hand, Club for Kids.

It's an awesome organization .. If you'd like to make an impact with me & change the world =>

https://t.co/AaI7ZGfPTh

Many thanks & God bless!

[EM Board bombs @EMBoardBombs]

PID dispo: admit if pregnant, unable to reliably complete outpatient therapy (assess access to medications), severe disease including TOA.
Outpatient tx = 500mg ceftriaxone IM once + doxycycline 100mg BID x10d + flagyl 500mg BID x14d
#WCW #WomensHealth

[Dan Magdziarz, DO @EMReimbursement]

Emergency Medicine => Reimbursement in 2023 and New AMA CPT Documentation Guidelines

This article is geared for EM physicians in the trenches!

https://t.co/TqGEvvtyVI

#FOAMed @ACEPNow @EMresidents @EmergencyDocs @EDPMA @ACOEP

[Dan Magdziarz, DO @EMReimbursement]

@efunkEM Keep in mind that your charting should support your Medical Decision Making.

i.e. not just that your "ordered" morphine, but rather =>

"The patient presented with severe arm pain after his fall and thus required IV morphine."

[Dan Magdziarz, DO @EMReimbursement]

@efunkEM Very astute & yes ... you are correct!

Starting Jan 2023, the final "section" of MDM aligns under "Risk of Complications and/or Morbidity or Mortality of Patient Management" =>

In this area, It takes only ONE element within a risk level for that level of risk to be attributed!

[Dan Magdziarz, DO @EMReimbursement]

@efunkEM Years ago my wife at bedside told the ER doctor ... "I'm pretty sure he's not going to leave the ER without a lumbar puncture." She was right!

Go where your clinical skills lead =>

Patient with HA, N/V, Photophobia, Stiff Neck - get ready to do the LP.

(regardless of the CBC)

[Dan Magdziarz, DO @EMReimbursement]

@EMHighAK @elewMD @TheShenger @drjgutt @SkylerLentz @sreeja_natesan @ercowboy @kaynani32 @MikePallaci @Chris_McStay @ResusOne @DaveLewMD @davidcarr333 @MRamzyDO @PulmCrit @EMinMiami @Dane_o_MD @rob_cosentini @petrosoniak ER Discharge instructions that will serve your patients (and your practice) very well =>

"Return to the ER if you are worse, have any problems, or develop new symptoms."

Disease processes evolve over time!

I communicate this with every patient and write out ... every time :)

[Dan Magdziarz, DO @EMReimbursement]

degree of complexity and risk that reside within a given patient encounter.

Your vigilance here will certainly be important to both your coders and payers!

#FOAMed @ACEPNow

[Dan Magdziarz, DO @EMReimbursement]

Examining the Playing Field => 2023 AMA CPT Documentation Guidelines & Your Emergency Medicine Reimbursement:

These new guidelines necessitate solely a "medically appropriate history and/or examination" for the majority of Emergency Department E/M encounters (CPT 99282 - 99285)

[Dan Magdziarz, DO @EMReimbursement]

in our new language of Emergency Medicine reimbursement.

As such, best practice charting should target in on Medical Decision Making elements.

Nonetheless, don't dismiss the value of detailing a solid History & Physical in 2023.

Your documentation of these will support the

[Dan Magdziarz, DO @EMReimbursement]

As a medical-legal aside, always include "other" in your
Differential Diagnosis ...both in your critical thinking and
everyday charting.

Be the outstanding clinician you were trained to be!

#FOAMed @ACEPnow

[Dan Magdziarz, DO @EMReimbursement]

Another Pearl for 2023 AMA CPT Documentation
Guidelines & Your Emergency Medicine Reimbursement:

The "threat to life or bodily function" that potentially
resides within certain encounters now matters - more
than ever!

Here's why (& how) to highlight this in your charting =>

[Dan Magdziarz, DO @EMReimbursement]

When appropriate, here's how your documentation
could look:

"Differential Diagnosis - GERD, Musculoskeletal,
Pneumonia, Pneumothorax, MI, PE, Other"

Let your coders know what you are thinking - this may
ultimately clarify those visits as 99284 / 99285 $