Level of E/M Service in the Emergency Department

Why can’t total time be used to determine the level of E/M service when a patient is seen in the Emergency Department?

•      • Time is not a descriptive component for the emergency department levels of E/M services because emergency department services are typically provided on a variable intensity basis, often involving multiple encounters with several patients over an extended period of time.

How can new vs. established patients be classified in the Emergency Department?

•      • Emergency Department Classification of New vs Established Patient
  •           ○ No distinction is made between new and established patients in the emergency department. 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.

Here are the codes.

•      • 99281 Emergency department visit for the evaluation and management of a patient that may not require the presence of a physician or other qualified health care professional
•      • 99282 Emergency department visit for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and straightforward medical decision making
•      • 99283 Emergency department visit for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and low level of medical decision making
•      • 99284 Emergency department visit for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and moderate level of medical decision making
•      • 99285 Emergency department visit for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and high level of medical decision making

This is my opinion.

Michael G. Warshaw

DPM, CPC

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