Outpatient Facility Coding Alert - 2018 Issue 4
Specialty Spotlight: Emergency Department: Understand When 99285 Is Too Much or Not Enough
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Article Overview
This emergency department coding article explains general documentation and level-of-service concepts that affect whether a visit is supported as a high-level ED evaluation and management service or instead aligns more closely with critical care. It is relevant to coders, billing staff, compliance teams, and emergency medicine clinicians who need to understand how documentation, medical necessity, and reported service level interact. The article also discusses comparative billing concerns, emergency department acuity considerations, and the relationship between ED visit coding, splinting, and related modifier use.
Why This Topic Matters
Accurate ED coding affects compliance, claim accuracy, and reimbursement, especially when higher-level visit reporting is under scrutiny. The article helps readers recognize when documentation and service intensity may support different billing categories.
Article Sections
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Know the Elements
This section discusses the general documentation components associated with higher-level emergency department evaluation and management reporting. It focuses on the broad categories of history, examination, and medical decision-making.
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MDM Is Not Enough
This section addresses the relationship between medical decision-making and the other documentation components needed for emergency department visit reporting. It also introduces general considerations for acuity-related documentation in the emergency department.
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Know When Critical Care Usurps 99285
This section compares emergency department visit coding with critical care-related reporting in a trauma scenario. It also touches on a separately reported procedure and associated modifier usage in the same encounter.
What You Will Learn
- How emergency department documentation elements relate to visit level selection
- Why medical decision-making alone may not be sufficient for a higher-level ED service
- How critical care considerations can affect emergency department coding
- How related procedures and modifiers may be discussed in the context of an ED encounter
Who Should Read This
- Emergency department coders
- Medical billing staff
- Compliance professionals
- Emergency medicine physicians
- Revenue cycle teams
Codes Discussed
Modifiers Discussed
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