11/28/2023    Texas Codingline Subscriber

Emergency Room Coding

My group takes call at our local hospital and this
necessitates seeing patients in the emergency room
(ER) on occasion. We are not all in agreeance
regarding what E/M codes should be used in this
scenario. We have come up with different
encounters:

-A patient seen in the ER. The patient is then
discharged to follow up for out patient care.

-A patient is seen in the ER and then admitted for
continued medical treatment.

-A patient is seen in the ER and emergently taken
straight to the operating room for surgical
treatment.

What E/M code series would you recommend using for
these different scenarios? Thank you for the help!

Texas Codingline Subscriber

Response: When a patient is seen in the emergency
room (ER) or in the emergency department of a
hospital, it is important to know the rules that
need to be followed regarding the billing of E/M
codes:
• Time is not a descriptive component for the
emergency department levels of E/M services
because emergency department services are
typically provided on a variable intensity basis,
often involving multiple encounters with several
patients over an extended period of time.
• Emergency department classification of new
versus established patient
• No distinction is made between new and
established patients in the emergency department.
E/M services in the emergency department category
may be reported for any new or established patient
who presents for treatment in the emergency
department.

Of course, it is important to know and understand
the E/M codes for services rendered in the
emergency room or the emergency department of a
hospital. The level of E/M service is based upon a
medically appropriate history and/or a medically
appropriate examination and medical decision
making. As stated above, time is not a component
for the emergency department levels of E/M
services.
• CPT 99281 Emergency department visit for the
evaluation and management of a patient that may
not require the presence of a physician or other
qualified health care professional
• CPT 99282 Emergency department visit for the
evaluation and management of a patient, which
requires a medically appropriate history and/or
examination and straightforward medical decision
making
• CPT 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
• CPT 99284 Emergency department visit for the
evaluation and management of a patient, which
requires a medically appropriate history and/or
examination and moderate level of medical decision
making
• CPT 99285 Emergency department visit for the
evaluation and management of a patient, which
requires a medically appropriate history and/or
examination and high level of medical decision
making

Issue #1: A patient seen in the ER. The patient is
then discharged to follow up for outpatient care.
In this scenario the appropriate level of E/M
service that was performed in the emergency
department is the appropriate E/M code to bill.

Issue #2: A patient is seen in the ER and then
admitted for continued medical treatment.
Per the CPT Manual, when a patient is admitted to
the hospital as an inpatient in the course of an
encounter in another site of service (eg. hospital
emergency department, observation status in a
hospital, office, nursing facility) all evaluation
and management services provided by that physician
in conjunction with that admission are considered
to be part of the initial hospital care when
performed on the same date as the admission. The
inpatient care level of service reported by the
admitting physician should include the services
related to the admission he/she provided in the
other sites of service as well as in the inpatient
setting.

Issue #3: A patient is seen in the ER and
emergently taken straight to the operating room
for surgical treatment. In this scenario the
appropriate level of E/M service that was
performed in the emergency department is the
appropriate E/M code to bill. Of course, since the
patient is having surgery performed, the 57
modifier would need to be appended to the E/M
service to indicate “Decision for Surgery.”

Michael G. Warshaw, DPM, CPC, Lady Lake, FL

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