Basics about Emergency department (ED) CPT code 99283

An Emergency Department (ED) is defined as an organized hospital-based facility for the provision of unscheduled episodic services to patients who present for immediate medical attention. The facility must be available 24 hours a day. The common reasons for ED visits are chest pain, abdominal pain, open wounds, fractures, contusions etc. Below is the description of level 3 ED CPT code 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

Coding Guidelines for ED codes (99281-99285)

Code selection for emergency department services (99282–99285) is based on level of medical decision making (MDM). The levels of MDM are defined based on three elements: number and complexity of problems addressed at the encounter; amount and or complexity of data to be reviewed and analyzed; and risk of complications and/or morbidity or mortality of patient management. To qualify for a particular level of MDM, two of the three elements for that level of MDM must be met or exceeded. Its important to note that time is not a descriptive component for the emergency department levels of E/M services.

Some of the common problems of the patient coming for ED level visit CPT code 99283

Read also: When to code Infusion and IV push CPT code in ED

When to assign Level 3 ED CPT code 99283

The main information about the patient ED visit is given in the MD note. In MD note, the physician will document in the Medical decision making (MDM) about the patient’s problems and which procedure are ordered and done. All the procedure should be confirmed with their clear separate document. For example, if an X-ray is done, then an X-ray report should be given in the radiology section.

Let us check when should ED level Procedure code 99283 is assign by ED medical coders

When the patient arrive to hospital in Ambulance

When the patient Mode of arrival (MOA) to the hospital is through Ambulance, the patient is considered a Level 3 ED visit code, 99283. Since, the patient is coming with ambulance, his condition is considered as moderate complex. If the patient has to go through any special exam like CT, MRI etc during the ED visiti, then the level of ED visit can change to level 4, 99284. 

In ED level 3, 99283 the patient is moderately complex but in ED level 4 (CPT code 99284) the patient condition is more complicated than level 3. 

Medicare Fee schedule for CPT code 99283

Below is the price, cost , reimbursement rate as per Medicare Fee schedule for different MAC and region/locality for CPT code 99283

Source link : https://www.cms.gov/medicare/physician-fee-schedule/search?Y=0&T=4&HT=0&CT=3&H1=99283&M=5

When the physician does laboratory tests or procedures

When the patient comes for an ED visit and the physician does any laboratory test, then the ED visit directly goes to the level 3 code, CPT code 992283. 

Since the patient is moderately complex, the physician order and performs laboratory procedures, to find any harmful disease or disorder.

When the physician order and does an EKG exam

When an physician performs and EKG (Echocardiogram or Echocardiography) for an ED visit, then that visit is assigned with ED level 3 code 99283. Here, the patient may be having an abnormality with heart, hence the patient condition is considered as moderately complex. 

If the patient has to go through any heart exam like CT heart, MRI chest, Ultrasound chest, then the ED level changes to code 99284, level 4.

Procedures with ED visit level code 99283

In ED level visit CPT code 99283, the patient will have a moderate severity problem. In some scenarios the patient may have to undergo some surgery procedures as well.

for ED code 99283, you may get simple repair, fracture reduction, etc procedure for ED visit medical report. The sample report for coding simple repair and placement for short leg splint are already shared in my recent post. 

You may get more coding information for ED level visit procedure code 99283 through sample coded ED visit medical report.

Evaluation and management services including new or established patient office or other outpatient services (99201-99215), emergency department services (99281-99285), nursing facility services (99304-99318), domiciliary, rest home, or custodial care services (99324-99337), home services (99341-99350), and preventive medicine services (99381-99397) on the same date related to the admission to “observation status” should not be reported separately.”

When to use 25 Modifier

1. Should a separately identifiable E/M service be provided on the same date that a diagnostic and/or therapeutic procedure(s) is performed, information substantiating the E/M service must be clearly documented in the patient’s medical record, to justify use of the modifier –25.

2. Modifier 25 may be appended only to E/M service codes and then only for those within the range of 99201-99499. For outpatient services paid under OPPS, the relevant code ranges are:

99201-99215 (Office or Outpatient Services)

99281-99285 (Emergency Department Services)

99291 (Critical Care Services)

99241-99245 (Office or Other Outpatient Consultations)

Example #1: A patient is seen in the ED with complaint of a rapid heartbeat. A 12-lead ECG is performed.

In this case, the appropriate code(s) from the following code ranges can be reported: 
99281-99285 (Emergency Department Services) with a modifier –25
93005 (Twelve lead ECG)

Example #2: A patient is seen in the ED after a fall. Lacerations sustained  from the fall are repaired and radiological x-rays are performed. In this case, the appropriate code(s) from the following code ranges can be reported:

99281-99285 (Emergency Department Services) with a modifier –25
12001-13160 (Repair/Closure of the Laceration)
70010-79900 (Radiological X-ray)

References:

http://www.medicalbillingcptmodifiers.com/2013/01/emergency-department-cpt-codes-99281.html