E/M Emergency Services

Aka: E/M Emergency Services, E/M Emergency, CPT 99281, CPT 99282, CPT 99283, CPT 99284, CPT 99285

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II. Indication

  1. Emergency Department Services

III. Approach

  1. Know your intended level of service from the start and document to meet that level of service
  2. HPI
    1. Code 99281 - 99283: Requires 1 of 8 component
    2. Code 99284 - 99285: Requires 4 of 8 components
  3. ROS
    1. Code 99281: Requires 0 component
    2. Code 99282 - 99283: Requires 1 component
    3. Code 99284: Requires 2 components
    4. Code 99285: Requires 10 components
  4. Past history, Family History and social history
    1. Code 99281 - 99283: Requires 0 component
    2. Code 99284: Requires 1 components
    3. Code 99285: Requires 2 components
  5. Physical exam
    1. Code 99281: Requires 1 component
    2. Code 99282 - 99283: Requires 2 components
    3. Code 99284: Requires 5 components
    4. Code 99285: Requires 8 components
  6. Number of problems (assign 1 to 4 points)
    1. Minor or self limited problems
    2. Established problems to examiner with or without testing
    3. New problems to examiner with or without diagnostic testing
  7. Reviewed Data (1 point each unless otherwise noted)
    1. Labs (ordered or reviewed)
    2. Imaging (ordered or reviewed)
    3. Diagnostic testing (ordered or reviewed)
    4. Discussion of test results with the performing physician (e.g. radiologist)
    5. Obtaining and reviewing outside records, history from source other than patient, discussing with other provider (2 points)
    6. Individual analysis, interpretation of imaging, tracing, or specimen
  8. Risk of morbidity, mortality or other complications
    1. Minimal risk
      1. Single self limited problem (e.g. rash)
      2. Diagnostic testing without risk (e.g. Urinalysis)
      3. Simple non-medication interventions (e.g. ace wrap)
    2. Low risk
      1. Two or more minor problems
      2. Low risk procedure (e.g. ABG, CT with contrast)
      3. Low level interventions (e.g. IV fluids)
    3. Moderate risk
      1. Chronic condition with mild exacerbation or acute systemic illness
      2. Moderate risk procedures (e.g. vascular imaging)
      3. Medications or minor surgery
    4. High risk
      1. Chronic condition with severe exacerbation or acute life-threatening systemic illness
      2. High risk procedures (e.g. vascular imaging with significant risk factors)
      3. Major surgery or Parenteral controlled substances
  9. References
    1. Johnson (2012) MN ACEP Reimbursement and Coding Conference, Minneapolis

IV. Approach: Critical Care

  1. Critical Care time >30 minutes
  2. Time spent requiring high complexity decision making
    1. to assess, manipulate and support vital organ system failure or
    2. Prevention of of further life threatening deterioration
  3. Additional measures counting toward Critical Care time (other procedures are billed separately)
    1. Pulse Oximetry
    2. Chest XRay Interpretation
    3. Blood Gas interpretation
    4. Gastric intubation
    5. Transcutaneous Pacing
    6. Ventilator management
    7. Vascular Access

V. Types: CPT Code 99281

  1. Key Components (All 3 meet or exceed requirements)
    1. E/M Problem Focused History
    2. E/M Problem Focused Exam
    3. E/M Straightforward Medical Decision
  2. E/M Self Limited or Minor Problem

VI. Types: CPT Code 99282

  1. Key Components (All 3 meet or exceed requirements)
    1. E/M Expanded Problem Focused History
    2. E/M Expanded Problem Focused Exam
    3. E/M Low Complexity Medical Decision
  2. Problem Severity
    1. E/M Low Severity Problem
    2. E/M Moderate Severity Problem

VII. Types: CPT Code 99283

  1. Key Components (All 3 meet or exceed requirements)
    1. E/M Expanded Problem Focused History
    2. E/M Expanded Problem Focused Exam
    3. E/M Moderate Complexity Medical Decision
  2. E/M Moderate Severity Problem

VIII. Types: CPT Code 99284

  1. Key Components (All 3 meet or exceed requirements)
    1. E/M Detailed History
    2. E/M Detailed Exam
    3. E/M Moderate Complexity Medical Decision
  2. Problem Severity
    1. E/M High Severity Problem

IX. Types: CPT Code 99285

  1. Key Components (All 3 meet or exceed requirements)
    1. E/M Comprehensive History
    2. E/M Comprehensive Exam
    3. E/M High Complexity Medical Decision
  2. Problem Severity
    1. E/M High Severity Problem

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