Organ System Failure

 Central nervous system failure 

 Hepatic Failure system failure 

 Encephalopathy 

 Stroke 

 Circulatory failure 

 Acute MI 

 Shock 

 Severe trauma 

 Encephalopathy 

 Coagulopathy 

 Metabolic failure 

 Toxic Ingestion (methanol) 

 Severe Acidosis 

 Respiratory Failure 

 Renal failure 

 New onset 

 Hyperkalemia 

 Pneumonia

Critical Care Requirements

 Clinical Requirement of high probability of Clinical Clinical Requirement Requirement of high probability probability of deterioration 

 Time requirement 

 Minimum 30 minutes 

 Excludes separate procedures

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