CPT code 99284 : Use of Emergency Department Level 4

Basics of ED CPT code 99284

An emergency department 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.

An ED is typically described as an organized hospital-based facility, available 24 hours a day, supplying or providing unscheduled episodic services to patients in need of immediate or urgent medical attention. ED codes are typically reported per day and do not differentiate between new or established patients. 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.

Earlier we have learnt about level 3 ED CPT code 99283, today we will learn about the level 4 ED CPT code 99284.

When to use Emergency Department CPT code 99284

Description of CPT code 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

Time as a Factor in the Emergency Department Setting

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.

When CT/MRI/US/Doppler exam done

When the physician order any special exam like Computed Tomography (CT) scan, MRI, Ultrasound (US), Doppler etc, then that patient ED visit is assigned with level 4 CPT code 99284. Since, the patient has to go through these special diagnostic exam, the patient condition is considered as highly complex, hence it is reported with ED level 4 CPT code 99284.

This level visit patient needs a very special attention, because if they are not taken care properly then their condition can worsen more. 

When mutiple X-ray Procedures are done

When the physician orders multiple x-rays, then also the patient ED visit is assigned with level 4 ED CPT code 99284. The patient if has acute injury, then the physician can order multiple x-ray to check for any fracture.

Such ED visit also needs a special attention because any fracture if not treated on time, can harm your body structure and will lead to more worse condition.

When extensive or complicated surgery procedures are performed

Percutaneous or Open surgery done during the ED visit, directly goes into the level 4 visit CPT code 99284. Since, the patient condition is very complicated,  the physician orders surgeries.  Extensive and complicated surgeries like catheter placement, fracture manipulation, heart catheterization, angioplasty, thrombectomy etc. will always lead to level 4 ED visit code 99284.

Intra service done for CPT code 99284

A patient presents to the ED with a progressing illness or acute injury that requires medical management or potential surgical treatment.

Obtain a medically appropriate history, including interviews with patient, physician office, nursing home, or EMS personnel, and family members and caregivers present or by phone as needed. Perform a medically appropriate physical examination. Formulate a diagnosis and treatment plan (moderate MDM). Enter orders in the EHR during the evaluation of the patient and begin the medical record. Communicate with other health care professionals as necessary during the encounter.

Review data from diagnostic testing and evaluate response to therapy by reassessing the patient and then adjusting the treatment plan accordingly. Formulate a discharge plan, included needed medications, therapies, and work or activity restrictions and recommendations. Arrange and review follow-up. Explain any prescriptions and treatments required along with discharge instructions and any follow-up care required, including reasons to return to the ED. Answer patient and/or family/caregiver questions.

Read also : When to use CPT code 29881, 29880 and G0289 together 

Top 5 Diagnosis Codes (ICD-10)

R10 Abdominal and pelvic pain 4.52%
M54 Dorsalgia 4.07%
M25 Other joint disorder, not elsewhere 2.93%
R07 Pain in throat and chest 2.72%
S09 Other and unspecified injuries 2.50%

               

RVU & Fees for CPT code 99284

Non-Facility Work MP PE RVU Total
2.74 0.27 0.57 3.58 N/A
Facility Work MP PE RVU Total
2.74 0.27 0.57 3.58 $121.32

Additional Code Information for CPT code 99284

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

 

XXX – Global days concept does not apply

Under the OPPS for Medicare patients, hospitals report Type A emergency department visits using codes 99281-99285. Hospitals report Type B emergency department visits using HCPCS codes G0380-G0384.

Note: Check with your carriers or local third-party payers for their specific reporting guidelines regarding these services.

G0380  Level 1 hospital emergency department visit provided in a type b emergency department; (the ed must meet at least one of the following requirements:

(1) it is licensed by the state in which it is located under applicable state law as an emergency room or emergency department;

(2) it is held out to the public (by name, posted signs, advertising, or other means) as a place that provides care for emergency medical conditions on an urgent basis without requiring a previously scheduled appointment; or

(3) during the calendar year immediately preceding the calendar year in which a determination under 42 cfr 489.24 is being made, based on a representative sample of patient visits that occurred during that calendar year, it provides at least one-third of all of its outpatient visits for the treatment of emergency medical conditions on an urgent basis without requiring a previously scheduled appointment)

39 Thoughts to “CPT code 99284 : Use of Emergency Department Level 4”

  1. […] APC 8009 (Extended Assessment and Management (EAM) Composite). A clinic visit (G0463), a Level 4 (99284) or Level 5 Type A ED visit (99285), or Level 5 Type B ED visit (G0384) furnished by a hospital in […]

  2. The ER Charged Him $6,500 for Six Stitches. No Wonder His Critically Ill Wife Avoided the ER. - News in Mag

    […] of TeamHealth, based in Knoxville. His ER visit was coded as Level 4 on the five-level scale. A Level 4 is supposed to require a detailed examination and medical history, along with decision-making of […]

  3. The ER Charged Him $6,500 for Six Stitches. No Wonder His Critically Ill Wife Avoided the ER. - Free Independent News

    […] of TeamHealth, based in Knoxville. His ER visit was coded as Level 4 on the five-level scale. A Level 4 is supposed to require a detailed examination and medical history, along with decision-making of […]

  4. Bill of the Month: Critically ill woman skips ER after spouse's costly stitches : Shots - News07trends

    […] based in Knoxville. Jason’s ER go to was coded as Degree 4 on the five-level scale. A Level 4 is meant to require an in depth examination and medical historical past, together with […]

  5. The ER Charged Him $6,500 for Six Stitches. No Wonder His Critically Ill Wife Avoided the ER. – American Exponent

    […] of TeamHealth, based in Knoxville. His ER visit was coded as Level 4 on the five-level scale. A Level 4 is supposed to require a detailed examination and medical history, along with decision-making of […]

  6. […] of TeamHealth, based in Knoxville. His ER visit was coded as Level 4 on the five-level scale. A Level 4 is supposed to require a detailed examination and medical history, along with decision-making of […]

  7. Bill of the Month: Critically ill woman skips ER after spouse’s costly stitches : Shots – Yakatme

    […] based in Knoxville. Jason’s ER visit was coded as Level 4 on the five-level scale. A Level 4 is supposed to require a detailed examination and medical history, along with decision-making of […]

  8. The ER Charged Him $6,500 for Six Stitches. No Wonder His Critically Ill Wife Avoided the ER. - Ahsan News

    […] of TeamHealth, based in Knoxville. His ER visit was coded as Level 4 on the five-level scale. A Level 4 is supposed to require a detailed examination and medical history, along with decision-making of […]

  9. The ER Charged Him $6,500 for Six Stitches. No Wonder His Critically Ill Wife Avoided the ER. - Health Planet

    […] of TeamHealth, based in Knoxville. His ER visit was coded as Level 4 on the five-level scale. A Level 4 is supposed to require a detailed examination and medical history, along with decision-making of […]

  10. The ER Charged Him $6,500 for Six Stitches. No Wonder His Critically Ill Wife Avoided the ER. | Choice Drug Card

    […] of TeamHealth, based in Knoxville. His ER visit was coded as Level 4 on the five-level scale. A Level 4 is supposed to require a detailed examination and medical history, along with decision-making of […]

  11. The ER Charged Him $6,500 for Six Stitches. No Wonder His Critically Ill Wife Avoided the ER. - Medical Coding Jobs

    […] of TeamHealth, based in Knoxville. His ER visit was coded as Level 4 on the five-level scale. A Level 4 is supposed to require a detailed examination and medical history, along with decision-making of […]

  12. The ER Charged Him $6,500 for Six Stitches. No Wonder His Critically Ill Wife Avoided the ER. - USVI News

    […] of TeamHealth, based in Knoxville. His ER visit was coded as Level 4 on the five-level scale. A Level 4 is supposed to require a detailed examination and medical history, along with decision-making of […]

  13. […] of TeamHealth, based in Knoxville. His ER visit was coded as Level 4 on the five-level scale. A Level 4 is supposed to require a detailed examination and medical history, along with decision-making of […]

  14. The ER Charged Him $6,500 for Six Stitches. No Wonder His Critically Ill Wife Avoided the ER. - Novel Coronavirus

    […] of TeamHealth, based in Knoxville. His ER visit was coded as Level 4 on the five-level scale. A Level 4 is supposed to require a detailed examination and medical history, along with decision-making of […]

  15. The ER Charged Him $6,500 for Six Stitches. No Wonder His Critically Ill Wife Avoided the ER. - Inspiration For Growth

    […] of TeamHealth, based in Knoxville. His ER visit was coded as Level 4 on the five-level scale. A Level 4 is supposed to require a detailed examination and medical history, along with decision-making of […]

  16. […] of TeamHealth, based in Knoxville. His ER visit was coded as Level 4 on the five-level scale. A Level 4 is supposed to require a detailed examination and medical history, along with decision-making of […]

  17. Bill of the Month: Critically ill woman skips ER after spouse’s costly stitches : Shots – Health News – NPR - updatem

    […] based in Knoxville. Jason’s ER visit was coded as Level 4 on the five-level scale. A Level 4 is supposed to require a detailed examination and medical history, along with decision-making of […]

  18. The ER Charged Him $6,500 for Six Stitches. No Wonder His Critically Ill Wife Avoided the ER. - LowerMyRx

    […] of TeamHealth, based in Knoxville. His ER visit was coded as Level 4 on the five-level scale. A Level 4 is supposed to require a detailed examination and medical history, along with decision-making of […]

  19. Bill of the Month: Critically ill woman skips ER after spouse's costly stitches : Shots - Atlanta Business Journal

    […] based in Knoxville. Jason’s ER visit was coded as Level 4 on the five-level scale. A Level 4 is supposed to require a detailed examination and medical history, along with decision-making of […]

  20. The ER Charged Him $6,500 for Six Stitches. No Marvel His Critically Ailing Spouse Averted the ER. - Ontariozillow

    […] primarily based in Knoxville. His ER go to was coded as Stage 4 on the five-level scale. A Level 4 is meant to require an in depth examination and medical historical past, together with […]

  21. […] based in Knoxville. Jason’s ER visit was coded as Level 4 on the five-level scale. A Level 4 is supposed to require a detailed examination and medical history, along with decision-making of […]

  22. […] based in Knoxville. Jason’s ER visit was coded as Level 4 on the five-level scale. A Level 4 is supposed to require a detailed examination and medical history, along with decision-making of […]

  23. […] based in Knoxville. Jason’s ER visit was coded as Level 4 on the five-level scale. A Level 4 is supposed to require a detailed examination and medical history, along with decision-making of […]

  24. The ER Charged Him $6,500 for Six Stitches. No Wonder His Critically Ill Wife Avoided the ER. - Inspiration For Growth

    […] of TeamHealth, based in Knoxville. His ER visit was coded as Level 4 on the five-level scale. A Level 4 is supposed to require a detailed examination and medical history, along with decision-making of […]

  25. […] based in Knoxville. Jason’s ER visit was coded as Level 4 on the five-level scale. A Level 4 is supposed to require a detailed examination and medical history, along with decision-making of […]

  26. The ER charged him $6,589.77 for 6 stitches, cost that led his wife to avoid ER - The News Global

    […] based in Knoxville. Jason’s ER visit was coded as Level 4 on the five-level scale. A Level 4 is supposed to require a detailed examination and medical history, along with decision-making of […]

  27. The ER Charged Him $6,500 For Six Stitches. No Surprise His Critically Ailing Spouse Prevented The ER.

    […] primarily based in Knoxville. His ER go to was coded as Stage 4 on the five-level scale. A Level 4 is meant to require an in depth examination and medical historical past, together with […]

  28. Bill of the Month: Critically ill woman skips ER after spouse’s costly stitches : Shots – Health News – NPR – healthclassicsz

    […] based in Knoxville. Jason’s ER visit was coded as Level 4 on the five-level scale. A Level 4 is supposed to require a detailed examination and medical history, along with decision-making of […]

  29. The ER Charged Him $6,500 for Six Stitches. No Wonder His Critically Ill Wife Avoided the ER. – Health News

    […] based mostly in Knoxville. His ER go to was coded as Degree 4 on the five-level scale. A Level 4 is meant to require an in depth examination and medical historical past, together with […]

  30. […] of TeamHealth, based in Knoxville. His ER visit was coded as Level 4 on the five-level scale. A Level 4 is supposed to require a detailed examination and medical history, along with decision-making of […]

  31. […] of TeamHealth, based in Knoxville. His ER visit was coded as Level 4 on the five-level scale. A Level 4 is supposed to require a detailed examination and medical history, along with decision-making of […]

  32. Ill Wife Avoided the Hospital Because the Emergency Room Charged Her Husband $6,500 for Six Stitches - New Jersey Digital News

    […] of TeamHealth, based in Knoxville. His ER visit was coded as Level 4 on the five-level scale. A Level 4 is supposed to require a detailed examination and medical history, along with decision-making of […]

  33. The ER Charged Him $6,500 for Six Stitches. No Wonder His Critically Ill Wife Avoided the ER. – Tag Me

    […] of TeamHealth, based in Knoxville. His ER visit was coded as Level 4 on the five-level scale. A Level 4 is supposed to require a detailed examination and medical history, along with decision-making of […]

  34. […] based in Knoxville. Jason’s ER visit was coded as Level 4 on the five-level scale. A Level 4 is supposed to require a detailed examination and medical history, along with decision-making of […]

  35. […] of TeamHealth, based in Knoxville. His ER visit was coded as Level 4 on the five-level scale. A Level 4 is supposed to require a detailed examination and medical history, along with decision-making of […]

  36. Bill of the Month: Critically ill woman skips ER after spouse’s costly stitches : Shots – Cybermark Solutions

    […] based in Knoxville. Jason’s ER visit was coded as Level 4 on the five-level scale. A Level 4 is supposed to require a detailed examination and medical history, along with decision-making of […]

  37. […] based in Knoxville. Jason’s ER visit was coded as Level 4 on the five-level scale. A Level 4 is supposed to require a detailed examination and medical history, along with decision-making of […]

  38. […] based in Knoxville. Jason’s ER visit was coded as Level 4 on the five-level scale. A Level 4 is supposed to require a detailed examination and medical history, along with decision-making of […]

  39. […] 99202, 99203, 99204, 99205, 99211, 99212, 99213, 99214, 99215, 99281, 99282, 99283, 99284, 99285, 99341, 99342, 99344, 99345, 99347, 99348, 99349, 99350 Do not code or report […]

Leave a Reply