ED E/M Codes Quick Tips

Any provider can use the emergency department codes (99281-99285), as long as the service is provided in the ED setting. There is not a requirement for the provider to be assigned to the ED to use these codes.

When an ED physician requests another physician to see the patient in the ED, both physicians should report an ED code, unless the patient is admitted. If the patient is admitted, the ED provider chooses a code from 99281-99285 and the physician admitting the patient through the ED will report an initial hospital care code (99221-99223).

If the patient is seen by both the ED physician and his or her personal physician in the ED, both providers report the ED service unless one of the providers admits the patient. In that case, the admitting physician will report the initial hospital care codes.

ED codes cannot be reported for services rendered in the physician’s office. The patient must be registered to the ED to use 99281-99285.

Example: A patient presents to the ED following a motor vehicle accident. The ED physician evaluates the patient’s injuries and requests an orthopedic physician see the patient to determine the proper treatment for a fractured tibia. The orthopedic physician evaluates the patient and determines that he needs surgery. The orthopedic physician admits the patient. In this case, the ED physician selects a code from 99281-99285 and the orthopedic physician selects a code from 99221-99233.

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John Verhovshek

John Verhovshek, MA, CPC, is Managing Editor at AAPC. He has covered medical coding and billing, healthcare policy, and the business of medicine since 1999. He is an alumnus of York College of Pennsylvania and Clemson University, and a member of the Asheville-Hendersonville AAPC Local Chapter.

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