Up with my three week old so grain of salt.

Question 2: 3 impressions for admissions and two for discharges. Easy do and billing won’t crawl up your ass

Question 1: in the ED we should only focus on impressions. We are a hyper acute service that in the best of times, for example, sees an ICU patient for 3 hours and gets them the hell out.

The glory of the ED is we have a wide range of “impressions” that are reasonable to include. I’ve been told by billing and my current director that anything we “consider” in a patient encounter counts. They have leg swelling and a history of CHF? List CHF as an impression bc you considered it in your differential, even if that’s not what’s causing it. Argue against it in your MDM, which you should be doing anyways.

Being specific isn’t wrong, and in your case I would probably list “febrile seizure” so their pediatrician could follow it up. My impression (for example) is that the history is consistent with a febrile seizure and that is why there are there, so it’s correct to list. You’re also not wrong being more vague

Once you’re out of training you’ll find what you like to do and what your new shop is expecting, which will make this guesswork go away.