The Current Procedural Terminology (CPT) codes 99281-99285 are used to report emergency department (ED) services provided to patients. These codes describe the level of care and complexity of services provided in the ED.
Here are the basic coding rules for CPT 99281-99285:
- Selection of the appropriate level of service should be based on the patient’s condition and the complexity of the services provided. The key components used to determine the level of service are the history, examination, and medical decision-making.
- The codes are time-based, which means that the level of service is determined based on the total time spent by the provider in providing the service. This includes the time spent on history-taking, examination, medical decision-making, and any coordination of care.
- Each code has specific requirements for the key components and total time spent, as outlined in the CPT manual. Providers should review these requirements carefully to ensure accurate coding.
- The ED services provided must be medically necessary and documented in the patient’s medical record. Documentation should include the patient’s presenting problem, the evaluation and management of the problem, and any treatment provided.
- If additional procedures are performed, such as suturing a wound or administering medication, separate codes should be used in addition to the ED service codes.
- The use of modifiers may be necessary to indicate unusual circumstances, such as critical care services provided in the ED.
- Billing for ED services should comply with all relevant laws and regulations, including those related to billing for services provided to Medicare and Medicaid patients.
It is important for providers to accurately code ED services to ensure appropriate reimbursement and to comply with billing regulations. Providers should also ensure that they are documenting all relevant information in the patient’s medical record to support the services provided and the level of care provided.