Requirements for reimbursement | Characteristics | |||
---|---|---|---|---|
ED-specific E&M Code | History | Examination | Medical decision-making | Severity of presenting problem |
99281 | Problem focused | Problem focused | Straightforward | Usually self-limited or minor |
99282 | Expanded problem focused | Expanded problem focused | Low complexity | Usually low to moderate |
99283 | Expanded problem focused | Expanded problem focused | Moderate complexity | Usually moderate |
99284 | Detailed | Detailed | Moderate complexity | Usually high, requiring urgent evaluation by physician, but not posing an immediate significant threat to life or physiological function |
99285 | Comprehensive | Comprehensive | High complexity | Usually high, posing an immediate significant threat to life or physiological function |
Critical care | Description | Requirements for reimbursement | ||
99291 | Evaluation and management of critically ill or critically injured patient; first 30–74 min | Constant physician attention; high complexity decision-making to assess, manipulate and support vital system function to prevent or treat single or multiple vital organ system failure.† | ||
99292 | Each additional 30 min |
Source: all text taken directly or paraphrased from AMA CPT descriptions except † from CMS Pub 100-4, 12, 30.6.12; note: all ED-specific E&M codes (99281–99285) include counselling and coordination of care ‘consistent with the nature of the problem(s) and/or family's needs’.
AMA, American Medical Society; CMS, Centers for Medicare & Medicaid Services; CPT, Current Procedural Terminology; ED, emergency department; E&M, evaluation and management.