Editors Note: This is the second installment in a series on reporting emergency service evaluation and management (E/M) codes. Future articles will cover codes 99283-99285.
Code 99282, the Level 2 emergency department
E/M code, is considered the least controversial of this series (99281-99285) because of the low level of history and physical exam required to meet the level of service. As discussed in the August issue of ECA, the Level 1 code 99281, is rarely used because most ED services will require more than a simple problem-focused history and problem-focused examination from the emergency physician. (See the article, Get Paid for Many Low-Level ED Services with 99281 in the August issue of ECA, page 62.)
If there is any question about which visits should be reported with 99282, it is whether the medical decision-making supports a Level 2 or whether it can actually support a Level 3, notes David McKenzie, reimbursement director for the Dallas, TX-based American College of Emergency Physicians (ACEP).
The level of medical decision-making (MDM) used by the physician is the only factor in determining whether a Level 2 or Level 3 (99283) code is reported for the emergency department visit, says McKenzie.
According to CPT, both 99282 and 99283 require an expanded problem-focused history and an expanded problem-focused examination. However, code 99282 requires decision-making of low complexity, while 99283 requires MDM of moderate complexity.
Using the Medicare Process Correctly
And although this sounds straight forward, reporting E/M services can be very confusing if you are relying solely on the information in your CPT Manual, admits John Turner, MD, FACEP, medical director of documentation and coding compliance for Team Health, Inc., a Knoxville, TN-based emergency physician staffing company, and a member of ACEPs coding and nomenclature advisory committee.
The manual is really of no help at all, he notes. What is the difference between low complexity and moderate complexity? If you look around the country, everybody and their Aunt Martha has their own homegrown formula for figuring out the level of medical decision-making. It is very difficult to standardize or quantify it because it is an individual subjective decision.
What many groups are now doing is deciding to use the Medicare process for determining the level of MDM, Turner states.
When Medicare auditors go over patient charts, they have a specific point system for assigning values to different parts of the E/M service, Turner explains. Most carriers have audit sheets used by their personnel when evaluating a physicians charts. Although designed for use by auditors, many physician groups [...]
