Navigate E/M Codes for Patients in the Emergency Department
Time is definitely NOT of the essence when it comes to ED coding. When a patient presents to the emergency department (ED), you’ve got a whole new set of evaluation and management (E/M) codes to choose from. And while they’re not that different from the office/outpatient E/M codes, there are some key differences that you must know if you want to code your claims correctly. Check out a few key facts you must know about the ED E/M codes. ED Codes Have 5 Levels Much like the outpatient E/M codes 99211-99215 (Office or other outpatient visit for the evaluation and management of an established patient …), the ED E/M codes have five levels, increasing in complexity as the numbers go higher. The ED code descriptors changed in 2023, with the updated codes below: You Won’t Find Time-Based Coding Options One key difference between the ED codes and the outpatient codes is that the office visit E/M services can be selected based on either medical decision making (MDM) or time spent. But the concept of time-based coding does not apply to ED visit codes. Why not? “Emergency department services are typically provided on a variable intensity basis, often involving multiple encounters with several patients over an extended period of time,” the AMA said in its CPT® Evaluation and Management (E/M) Code and Guideline Changes. “Therefore, it is often difficult to provide accurate estimates of the time spent face-to-face with the patient.” Don’t Look for New or Established Criteria Another big difference between the office and ED E/M codes is that you won’t have to determine whether the patient is new or established while evaluating your coding options in the ED. Why not? “No distinction is made between new and established patients in the emergency department,” says Part B Medicare Administrative Contractor (MAC) Palmetto GBA. “E/M services in the emergency department category may be reported for any new or established patient who presents for treatment in the emergency department.” For instance, even if you saw a patient yesterday for a level 2 ED visit involving a high fever and then you saw the same patient today for a level 3 ED visit involving a broken toe, you can report 99282 for the first day and 99283 for the second day without any issues. You’ll Select Your Codes Based on MDM Alone The correct way to choose the right E/M code for services in the ED is to base it on MDM. Use the following criteria when choosing your code: When reporting ED E/M codes, ensure that your provider documents the following: Check Out These Examples To get a firm handle on how to report the emergency department E/M levels, look at the three examples below: Example 1: A patient who presented to the ED on Wednesday for a nosebleed returns on Thursday saying they were unable to remove the packing from their left nostril on their own. The nurse removes the packing, and the patient returns home. For this uncomplicated visit, you’d report 99281. Example 2: A patient presents to the ED with cuts on both hands and their face that they sustained while climbing a fence. The provider reviews their records and finds that the patient received a tetanus shot the year prior. The patient is not in severe pain, and the cuts require only bandaging, not stitches. For this visit, you’ll report 99283. Example 3: A patient comes to the ED via ambulance with severe chest pains and the provider orders an electrocardiogram (ECG) and blood tests. The provider also reviews the patient’s previous records and speaks with the cardiologist on call before administering several medications. The patient is diagnosed with acute myocardial infarction. When symptom relief is not achieved, the provider calls the thoracic surgeon, and a bypass is performed. For this visit, you’ll report 99285. Torrey Kim, Contributing Writer, Raleigh, NC
