These codes are used to report emergency department E/M services. There are five levels of care. There is significant variability in payment, depending upon the code billed, so it is important to select the level of care which matches the clinical circumstances of the patient to optimize reimbursement.
For these encounters, the level of care may be selected based on the MDM required. There is no option to code based on time for these services.
The rules for performing and documenting emergency department E/M services are covered extensively in the EMERGENCY DEPARTMENT E/M SERVICES course, which includes examples for all levels of care as well as detailed explanations of the MDM and documentation required for each visit.
The 99281 level of care does NOT require the presence of a physician. This code is used for only 0.02% of emergency department visits. The reimbursement is about $11.
The 99282 level of care requires straightforward complexity MDM. This code is used for only 1.39% of emergency department visits. The reimbursement is about $40.
The 99283 level of care requires low complexity MDM. This code is used for 10.48% of emergency department visits. The reimbursement is about $69.
The 99284 level of care requires moderate complexity MDM. This code is used for 24.7% of emergency department visits. The reimbursement is about $118.
The 99285 level of care requires high complexity MDM. This code is used for 63.21% of emergency department visits. The reimbursement is about $171.