Risk

 The third part of the overall Medical decision The third part of the overall overall Medical Medical decision decision Making 

 The Risk Table is an official part of CMS Documentation Guidelines 

 Is scored independently 

 Along with Management Options and Amount and  Complexity of Data 

 Highest level of risk in any category determines the overall risk score

Nature of Presenting Problem

 99281 Usually, the presenting problems are self limited or minor 

 99282 Usually, the presenting problem(s) are of problem(s) are of low to moderate to moderate  severity 

 99283 Usually, the presenting problem(s) are of problem(s) are of moderate severity moderate severity.

 99284 Usually, the presenting problem(s) are of high severity, and require urgent evaluation by the physician but do not by the physician physician but do not pose an immediate significant threat to life or physiologic function. 

 99285 Usually, the presenting problem(s) are of high severity and pose an immediate 18 are of high severity and pose an immediate immediate significant threat to life of physiologic function.

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