Evaluation and Management Coding for Emergency Medicine

Evaluation and Management Codes

 99281 

 99282 

 99283 

 99284 

 99285  

 Critical Care 99291 

 +99292

There are three key components that must be met to correctly assign an must be met to correctly correctly assign an Evaluation and Management code: 

History 

Exam 

Medical Decision Making

CPT E/M Components Other

 Nature of the presenting problem Nature of the presenting presenting problem problem 

 99283 vs. 99284 

 Time 

 Critical Care

Medical decision making  dictates the highest level code that can be chosen  – Proper documentation supports   your choice

Medical Decision Making

Levels of Medical Decision Making

 Straight Forward  

 99281 

 Low Complexity 

 99282 

 Moderate Complexity 

 99283 and 99284 

 High Complexity 

 99285

DOCUMENTATION OF MEDICAL DECISION MAKING

■The number of possible diagnoses that must be considered 

 Chest pain patient 

 Diff Dx chest pain: Angina, Diff Dx chest pain: Angina, PTx, GERD 

 Final Diagnosis GERD 

 The type The type of management options of management options  

 Rx drug management, IV fluids, ement, IV fluids, parenteral parenteral narcotics 

 The amount and/or complexity of information that must be obtained, reviewed, and analyzed 

 Labs, X Labs, X-rays, EKGs, Medical records reviewed