CPT code 99283: When to assign ED Level 3

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 (9928299285) 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

Injury involving direct blow to the head with completed
neurological exam.
Acute pain, unknown etiology
Abscesses
Fever 100.5 or greater
Any condition for which prescription medication is
prescribed.
Complaints of SOB, CP, HA, abdominal pain, or allergic
reaction without further workup in the ER

When to assign ED Level 3 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

HCPCS CodeModifierShort DescriptionMac LocalityNon-Facility PriceFacility PriceNon-Facility Limiting ChargeFacility Limiting ChargeGPCI WorkGPCI PEGPCI MPProc StatWork RVUTransitioned Non-FAC PE RVUFully Implemented Non-FAC PE RVUTransitioned Facility PE RVUFully Implemented Facility PE RVUMP RVUTransitioned Non-FAC TotalTransitioned Facility TotalFully Implemented Non-Fac TotalFully Implemented Facility TotalGlobalPhys SupvConv FactDiag Imaging Family IndOpps Non-Facility Payment AmountOpps Facility Payment Amount
99283Emergency dept visit low mdm0NA$72.18NA$78.86111A1.60.350.350.350.350.182.132.132.132.13XXX933.887299NANA
99283Emergency dept visit low mdm111205NA$77.72NA$84.911.08200000000000011.37400000000000010.45200000000000001A1.60.350.350.350.350.182.132.132.132.13XXX933.887299NANA
99283Emergency dept visit low mdm111206NA$77.72NA$84.911.08200000000000011.37400000000000010.45200000000000001A1.60.350.350.350.350.182.132.132.132.13XXX933.887299NANA
99283Emergency dept visit low mdm111207NA$77.72NA$84.911.08200000000000011.37400000000000010.45200000000000001A1.60.350.350.350.350.182.132.132.132.13XXX933.887299NANA
99283Emergency dept visit low mdm111209NA$78.79NA$86.081.09800000000000011.4090.41699999999999998A1.60.350.350.350.350.182.132.132.132.13XXX933.887299NANA
99283Emergency dept visit low mdm111251NA$75.12NA$82.071.05099999999999991.26499999999999990.51300000000000001A1.60.350.350.350.350.182.132.132.132.13XXX933.887299NANA
99283Emergency dept visit low mdm111252NA$77.93NA$85.141.08200000000000011.37400000000000010.48699999999999999A1.60.350.350.350.350.182.132.132.132.13XXX933.887299NANA
99283Emergency dept visit low mdm111253NA$74.96NA$81.891.05099999999999991.26499999999999990.48699999999999999A1.60.350.350.350.350.182.132.132.132.13XXX933.887299NANA
99283Emergency dept visit low mdm111254NA$72.71NA$79.441.02699999999999991.0790.69399999999999995A1.60.350.350.350.350.182.132.132.132.13XXX933.887299NANA
99283Emergency dept visit low mdm111255NA$71.69NA$78.321.02099999999999991.0790.57899999999999996A1.60.350.350.350.350.182.132.132.132.13XXX933.887299NANA
99283Emergency dept visit low mdm111256NA$71.69NA$78.321.02099999999999991.0790.57899999999999996A1.60.350.350.350.350.182.132.132.132.13XXX933.887299NANA
99283Emergency dept visit low mdm111257NA$71.69NA$78.321.02099999999999991.0790.57899999999999996A1.60.350.350.350.350.182.132.132.132.13XXX933.887299NANA
99283Emergency dept visit low mdm111258NA$71.69NA$78.321.02099999999999991.0790.57899999999999996A1.60.350.350.350.350.182.132.132.132.13XXX933.887299NANA
99283Emergency dept visit low mdm111259NA$71.69NA$78.321.02099999999999991.0790.57899999999999996A1.60.350.350.350.350.182.132.132.132.13XXX933.887299NANA
99283Emergency dept visit low mdm111260NA$71.69NA$78.321.02099999999999991.0790.57899999999999996A1.60.350.350.350.350.182.132.132.132.13XXX933.887299NANA
99283Emergency dept visit low mdm111261NA$71.69NA$78.321.02099999999999991.0790.57899999999999996A1.60.350.350.350.350.182.132.132.132.13XXX933.887299NANA
99283Emergency dept visit low mdm111262NA$73.79NA$80.621.02099999999999991.0790.92400000000000004A1.60.350.350.350.350.182.132.132.132.13XXX933.887299NANA
99283Emergency dept visit low mdm111263NA$72.97NA$79.721.0361.1190.57899999999999996A1.60.350.350.350.350.182.132.132.132.13XXX933.887299NANA
99283Emergency dept visit low mdm111264NA$74.09NA$80.941.051.1490.57899999999999996A1.60.350.350.350.350.182.132.132.132.13XXX933.887299NANA
99283Emergency dept visit low mdm111265NA$79.78NA$87.161.09800000000000011.4090.57899999999999996A1.60.350.350.350.350.182.132.132.132.13XXX933.887299NANA
99283Emergency dept visit low mdm111266NA$73.75NA$80.571.03099999999999991.20700000000000010.57899999999999996A1.60.350.350.350.350.182.132.132.132.13XXX933.887299NANA
99283Emergency dept visit low mdm111267NA$74.00NA$80.841.0361.20500000000000010.57899999999999996A1.60.350.350.350.350.182.132.132.132.13XXX933.887299NANA
99283Emergency dept visit low mdm111268NA$71.69NA$78.321.02099999999999991.0790.57899999999999996A1.60.350.350.350.350.182.132.132.132.13XXX933.887299NANA
99283Emergency dept visit low mdm111269NA$71.69NA$78.321.02099999999999991.0790.57899999999999996A1.60.350.350.350.350.182.132.132.132.13XXX933.887299NANA
99283Emergency dept visit low mdm111270NA$71.69NA$78.321.02099999999999991.0790.57899999999999996A1.60.350.350.350.350.182.132.132.132.13XXX933.887299NANA
99283Emergency dept visit low mdm111275NA$71.69NA$78.321.02099999999999991.0790.57899999999999996A1.60.350.350.350.350.182.132.132.132.13XXX933.887299NANA
99283Emergency dept visit low mdm118217NA$73.89NA$80.731.02699999999999991.1810.68899999999999995A1.60.350.350.350.350.182.132.132.132.13XXX933.887299NANA
99283Emergency dept visit low mdm118218NA$75.13NA$82.081.04499999999999991.18500000000000010.72399999999999998A1.60.350.350.350.350.182.132.132.132.13XXX933.887299NANA
99283Emergency dept visit low mdm118226NA$75.13NA$82.081.04499999999999991.18500000000000010.72399999999999998A1.60.350.350.350.350.182.132.132.132.13XXX933.887299NANA
99283Emergency dept visit low mdm118271NA$71.79NA$78.431.02099999999999991.0790.59499999999999997A1.60.350.350.350.350.182.132.132.132.13XXX933.887299NANA
99283Emergency dept visit low mdm118272NA$73.54NA$80.341.0321.17599999999999990.59599999999999997A1.60.350.350.350.350.182.132.132.132.13XXX933.887299NANA
99283Emergency dept visit low mdm118273NA$72.07NA$78.731.02099999999999991.1110.57899999999999996A1.60.350.350.350.350.182.132.132.132.13XXX933.887299NANA
99283Emergency dept visit low mdm118274NA$73.37NA$80.161.03099999999999991.1750.57899999999999996A1.60.350.350.350.350.182.132.132.132.13XXX933.887299NANA
99283Emergency dept visit low mdm121201NA$71.74NA$78.381.00299999999999991.14599999999999990.61799999999999999A1.60.350.350.350.350.182.132.132.132.13XXX933.887299NANA
99283Emergency dept visit low mdm131200NA$72.78NA$79.51111.0980000000000001A1.60.350.350.350.350.182.132.132.132.13XXX933.887299NANA
99283Emergency dept visit low mdm210201NA$98.05NA$107.121.51.10000000000000010.60299999999999998A1.60.350.350.350.350.182.132.132.132.13XXX933.887299NANA
99283Emergency dept visit low mdm220200NA$67.49NA$73.7310.893000000000000020.439A1.60.350.350.350.350.182.132.132.132.13XXX933.887299NANA
99283Emergency dept visit low mdm230201NA$71.77NA$78.411.0181.0830.61199999999999999A1.60.350.350.350.350.182.132.132.132.13XXX933.887299NANA
99283Emergency dept visit low mdm230299NA$69.27NA$75.6810.965999999999999970.58899999999999997A1.60.350.350.350.350.182.132.132.132.13XXX933.887299NANA
99283Emergency dept visit low mdm240202NA$75.62NA$82.621.03899999999999991.20700000000000010.81499999999999995A1.60.350.350.350.350.182.132.132.132.13XXX933.887299NANA
99283Emergency dept visit low mdm240299NA$71.28NA$77.871.00299999999999991.02699999999999990.77300000000000002A1.60.350.350.350.350.182.132.132.132.13XXX933.887299NANA
99283Emergency dept visit low mdm310200NA$70.86NA$77.4110.962999999999999970.85499999999999998A1.60.350.350.350.350.182.132.132.132.13XXX933.887299NANA
99283Emergency dept visit low mdm320201NA$72.05NA$78.71110.97799999999999998A1.60.350.350.350.350.182.132.132.132.13XXX933.887299NANA
99283Emergency dept visit low mdm330201NA$68.97NA$75.35110.47399999999999998A1.60.350.350.350.350.182.132.132.132.13XXX933.887299NANA
99283Emergency dept visit low mdm340202NA$68.30NA$74.62110.36399999999999999A1.60.350.350.350.350.182.132.132.132.13XXX933.887299NANA
99283Emergency dept visit low mdm350209NA$70.48NA$77.0010.926000000000000050.86499999999999999A1.60.350.350.350.350.182.132.132.132.13XXX933.887299NANA
99283Emergency dept visit low mdm360221NA$70.90NA$77.46110.79A1.60.350.350.350.350.182.132.132.132.13XXX933.887299NANA
99283Emergency dept visit low mdm411201NA$71.81NA$78.451.00499999999999991.050.79700000000000004A1.60.350.350.350.350.182.132.132.132.13XXX933.887299NANA
99283Emergency dept visit low mdm421205NA$72.05NA$78.7110.902000000000000021.169A1.60.350.350.350.350.182.132.132.132.13XXX933.887299NANA
99283Emergency dept visit low mdm431200NA$69.60NA$76.0310.886000000000000010.79800000000000004A1.60.350.350.350.350.182.132.132.132.13XXX933.887299NANA
99283Emergency dept visit low mdm441209NA$71.60NA$78.221.02299999999999991.0140.67300000000000004A1.60.350.350.350.350.182.132.132.132.13XXX933.887299NANA
99283Emergency dept visit low mdm441211NA$71.54NA$78.161.01699999999999991.01699999999999990.71099999999999997A1.60.350.350.350.350.182.132.132.132.13XXX933.887299NANA
99283Emergency dept visit low mdm441215NA$71.77NA$78.411.02299999999999991.01299999999999990.70299999999999996A1.60.350.350.350.350.182.132.132.132.13XXX933.887299NANA
99283Emergency dept visit low mdm441218NA$74.56NA$81.451.02299999999999991.0161.1539999999999999A1.60.350.350.350.350.182.132.132.132.13XXX933.887299NANA
99283Emergency dept visit low mdm441220NA$69.75NA$76.2010.924000000000000040.749A1.60.350.350.350.350.182.132.132.132.13XXX933.887299NANA
99283Emergency dept visit low mdm441228NA$71.14NA$77.721.01299999999999990.9960.72099999999999997A1.60.350.350.350.350.182.132.132.132.13XXX933.887299NANA
99283Emergency dept visit low mdm441231NA$71.14NA$77.7211.05299999999999990.72699999999999998A1.60.350.350.350.350.182.132.132.132.13XXX933.887299NANA
99283Emergency dept visit low mdm441299NA$70.12NA$76.6010.950.75900000000000001A1.60.350.350.350.350.182.132.132.132.13XXX933.887299NANA
99283Emergency dept visit low mdm510200NA$67.70NA$73.9710.910.441A1.60.350.350.350.350.182.132.132.132.13XXX933.887299NANA
99283Emergency dept visit low mdm520200NA$68.02NA$74.3110.907000000000000030.499A1.60.350.350.350.350.182.132.132.132.13XXX933.887299NANA
99283Emergency dept visit low mdm530201NA$71.39NA$78.0010.963999999999999970.94099999999999995A1.60.350.350.350.350.182.132.132.132.13XXX933.887299NANA
99283Emergency dept visit low mdm530202NA$71.25NA$77.8410.951999999999999960.94099999999999995A1.60.350.350.350.350.182.132.132.132.13XXX933.887299NANA
99283Emergency dept visit low mdm530299NA$69.86NA$76.3210.854999999999999980.90100000000000002A1.60.350.350.350.350.182.132.132.132.13XXX933.887299NANA
99283Emergency dept visit low mdm540200NA$66.69NA$72.8610.913000000000000030.26900000000000002A1.60.350.350.350.350.182.132.132.132.13XXX933.887299NANA
99283Emergency dept visit low mdm610212NA$75.76NA$82.7710.931.7230000000000001A1.60.350.350.350.350.182.132.132.132.13XXX933.887299NANA
99283Emergency dept visit low mdm610215NA$76.44NA$83.521.00699999999999991.05499999999999991.53A1.60.350.350.350.350.182.132.132.132.13XXX933.887299NANA
99283Emergency dept visit low mdm610216NA$78.82NA$86.111.00899999999999991.03299999999999991.9450000000000001A1.60.350.350.350.350.182.132.132.132.13XXX933.887299NANA
99283Emergency dept visit low mdm610299NA$72.86NA$79.6010.912000000000000031.282A1.60.350.350.350.350.182.132.132.132.13XXX933.887299NANA
99283Emergency dept visit low mdm620200NA$68.29NA$74.6111.01899999999999990.32600000000000001A1.60.350.350.350.350.182.132.132.132.13XXX933.887299NANA
99283Emergency dept visit low mdm630200NA$67.40NA$73.6410.950.314A1.60.350.350.350.350.182.132.132.132.13XXX933.887299NANA
99283Emergency dept visit low mdm710213NA$67.34NA$73.5710.852999999999999980.49199999999999999A1.60.350.350.350.350.182.132.132.132.13XXX933.887299NANA
99283Emergency dept visit low mdm720201NA$73.45NA$80.2410.931000000000000051.3420000000000001A1.60.350.350.350.350.182.132.132.132.13XXX933.887299NANA
99283Emergency dept visit low mdm720299NA$71.59NA$78.2110.8761.1439999999999999A1.60.350.350.350.350.182.132.132.132.13XXX933.887299NANA
99283Emergency dept visit low mdm730200NA$68.66NA$75.0110.846999999999999980.72A1.60.350.350.350.350.182.132.132.132.13XXX933.887299NANA
99283Emergency dept visit low mdm810200NA$67.92NA$74.2110.911000000000000030.47499999999999998A1.60.350.350.350.350.182.132.132.132.13XXX933.887299NANA
99283Emergency dept visit low mdm820201NA$76.17NA$83.2210.991999999999999991.67A1.60.350.350.350.350.182.132.132.132.13XXX933.887299NANA
99283Emergency dept visit low mdm820299NA$71.59NA$78.2110.911000000000000031.0760000000000001A1.60.350.350.350.350.182.132.132.132.13XXX933.887299NANA
99283Emergency dept visit low mdm910203NA$77.14NA$84.2710.9991.8149999999999999A1.60.350.350.350.350.182.132.132.132.13XXX933.887299NANA
99283Emergency dept visit low mdm910204NA$82.02NA$89.6011.02499999999999992.5640000000000001A1.60.350.350.350.350.182.132.132.132.13XXX933.887299NANA
99283Emergency dept visit low mdm910299NA$74.22NA$81.0810.941.4510000000000001A1.60.350.350.350.350.182.132.132.132.13XXX933.887299NANA
99283Emergency dept visit low mdm920220NA$72.18NA$78.86111A1.60.350.350.350.350.182.132.132.132.13XXX933.887299NANA
99283Emergency dept visit low mdm920250NA$72.18NA$78.86111A1.60.350.350.350.350.182.132.132.132.13XXX933.887299NANA
99283Emergency dept visit low mdm1011200NA$69.20NA$75.6010.8780.748A1.60.350.350.350.350.182.132.132.132.13XXX933.887299NANA
99283Emergency dept visit low mdm1021201NA$72.25NA$78.9410.9981.016A1.60.350.350.350.350.182.132.132.132.13XXX933.887299NANA
99283Emergency dept visit low mdm1021299NA$70.86NA$77.4110.881000000000000011.0149999999999999A1.60.350.350.350.350.182.132.132.132.13XXX933.887299NANA
99283Emergency dept visit low mdm1031235NA$67.98NA$74.2710.894000000000000020.51800000000000002A1.60.350.350.350.350.182.132.132.132.13XXX933.887299NANA
99283Emergency dept visit low mdm1120201NA$69.60NA$76.0410.908000000000000030.75600000000000001A1.60.350.350.350.350.182.132.132.132.13XXX933.887299NANA
99283Emergency dept visit low mdm1130200NA$71.00NA$77.5710.990.82599999999999996A1.60.350.350.350.350.182.132.132.132.13XXX933.887299NANA
99283Emergency dept visit low mdm1140216NA$72.14NA$78.8210.861.266A1.60.350.350.350.350.182.132.132.132.13XXX933.887299NANA
99283Emergency dept visit low mdm1150200NA$69.74NA$76.1910.927000000000000050.74199999999999999A1.60.350.350.350.350.182.132.132.132.13XXX933.887299NANA
99283Emergency dept visit low mdm1210201NA$72.26NA$78.951.00699999999999991.00699999999999990.93799999999999994A1.60.350.350.350.350.182.132.132.132.13XXX933.887299NANA
99283Emergency dept visit low mdm1220201NA$79.16NA$86.491.0561.2141.2310000000000001A1.60.350.350.350.350.182.132.132.132.13XXX933.887299NANA
99283Emergency dept visit low mdm1230201NA$76.41NA$83.481.0241.0871.3109999999999999A1.60.350.350.350.350.182.132.132.132.13XXX933.887299NANA
99283Emergency dept visit low mdm1230299NA$73.23NA$80.001.01099999999999991.02699999999999991.022A1.60.350.350.350.350.182.132.132.132.13XXX933.887299NANA
99283Emergency dept visit low mdm1240201NA$77.40NA$84.561.0561.18599999999999990.996A1.60.350.350.350.350.182.132.132.132.13XXX933.887299NANA
99283Emergency dept visit low mdm1240299NA$75.85NA$82.871.03899999999999991.12400000000000011.014A1.60.350.350.350.350.182.132.132.132.13XXX933.887299NANA
99283Emergency dept visit low mdm1250201NA$75.38NA$82.351.02299999999999991.06800000000000011.1879999999999999A1.60.350.350.350.350.182.132.132.132.13XXX933.887299NANA
99283Emergency dept visit low mdm1250299NA$70.81NA$77.3610.933000000000000050.90600000000000003A1.60.350.350.350.350.182.132.132.132.13XXX933.887299NANA
99283Emergency dept visit low mdm1310200NA$75.44NA$82.421.031.10200000000000011.07A1.60.350.350.350.350.182.132.132.132.13XXX933.887299NANA
99283Emergency dept visit low mdm1320201NA$82.81NA$90.471.06099999999999991.18399999999999991.843A1.60.350.350.350.350.182.132.132.132.13XXX933.887299NANA
99283Emergency dept visit low mdm1320202NA$85.70NA$93.631.0561.2122.3069999999999999A1.60.350.350.350.350.182.132.132.132.13XXX933.887299NANA
99283Emergency dept visit low mdm1320203NA$78.17NA$85.401.0361.1051.458A1.60.350.350.350.350.182.132.132.132.13XXX933.887299NANA
99283Emergency dept visit low mdm1328299NA$70.04NA$76.5210.951999999999999960.74199999999999999A1.60.350.350.350.350.182.132.132.132.13XXX933.887299NANA
99283Emergency dept visit low mdm1329204NA$84.47NA$92.291.06099999999999991.2122.0609999999999999A1.60.350.350.350.350.182.132.132.132.13XXX933.887299NANA
99283Emergency dept visit low mdm1411203NA$70.13NA$76.6111.00499999999999990.65400000000000003A1.60.350.350.350.350.182.132.132.132.13XXX933.887299NANA
99283Emergency dept visit low mdm1411299NA$68.92NA$75.3010.905000000000000030.65100000000000002A1.60.350.350.350.350.182.132.132.132.13XXX933.887299NANA
99283Emergency dept visit low mdm1421201NA$76.19NA$83.231.04499999999999991.20.86799999999999999A1.60.350.350.350.350.182.132.132.132.13XXX933.887299NANA
99283Emergency dept visit low mdm1421299NA$72.99NA$79.741.0221.06099999999999990.81899999999999995A1.60.350.350.350.350.182.132.132.132.13XXX933.887299NANA
99283Emergency dept visit low mdm1431240NA$72.04NA$78.7011.0360.90700000000000003A1.60.350.350.350.350.182.132.132.132.13XXX933.887299NANA
99283Emergency dept visit low mdm1441201NA$73.43NA$80.221.02299999999999991.0440.91500000000000004A1.60.350.350.350.350.182.132.132.132.13XXX933.887299NANA
99283Emergency dept visit low mdm1451250NA$69.36NA$75.7710.9970.54300000000000004A1.60.350.350.350.350.182.132.132.132.13XXX933.887299NANA
99283Emergency dept visit low mdm1510200NA$69.88NA$76.3410.8730.87A1.60.350.350.350.350.182.132.132.132.13XXX933.887299NANA
99283Emergency dept visit low mdm1520200NA$71.52NA$78.1410.912000000000000031.0629999999999999A1.60.350.350.350.350.182.132.132.132.13XXX933.887299NANA

               

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.

Additional Code Information for CPT code 99283
PC/TC Indicator (26):              0 = Physician Service Codes
Multiple Procedures (51):        0 = No payment adjustment rules for multiple procedures apply
Bilateral Surgery (50):              0 = 150% payment adjustment for bilateral procedures does not apply
Physician Supervision:             09 = Concept does not apply
Assistant Surgeon (80,82):        0 = Payment restriction for assistants at surgery applies to this procedure unless supporting documentation is submitted
Co-Surgeons (62):                       0 = Co-surgeons not permitted for this procedure
Team Surgery (66):                     0 = Team surgeons not permitted for this procedure
Diagnostic Imaging Family:       99 = Concept does not apply

 

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

One Thought to “CPT code 99283: When to assign ED Level 3”

  1. […] do not differentiate between new or established patients. Earlier we have learnt about level 3 ED CPT code 99283, today we will learn about the level 4 ED CPT code […]

Leave a Reply