Unit 6 Discussion- Evaluation and Management Services- CPT Codes 99202 - 99499

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1 Evaluation and Management Services: CPT Codes 99202 - 99499 Krystina Taylor Medical Coding & Billing, Herzing University MC165-7 – Current Procedural Terminology Coding 1 Jean Andrick October 9, 2023

2 Evaluation and Management Services: CPT Codes 99202 - 99499 System: Evaluation and Management Services Title: Evaluation and Management Services – Emergency Department Services – New or Established Patient Guidelines: The provided codes are utilized to document the assessment and management services administered within the emergency department. Notably, there is no distinction made between new and existing patients when it comes to emergency department care. An emergency department, in this context, refers to a hospital-based facility that is organized to provide unscheduled, episodic medical services to patients who require immediate attention. This facility must be operational 24 hours a day. When critical care services are delivered in the emergency department, you should refer to the Critical Care guidelines and use codes 99291 and 99292. It's important to note that both critical care and emergency department services can be reported on the same day if, after the initial emergency department care, the patient's condition changes, necessitating critical care services. For evaluation and management services provided to a patient in observation status, you should refer to codes 99221, 99222, and 99223 for the initial observation encounter, and codes 99231, 99232, 99233, 99238, and 99239 for subsequent observation encounters or discharge from a hospital inpatient or observation status. In cases of hospital inpatient or observation care services, which include admission and discharge services, refer to codes 99234, 99235, and 99236. When you need to document services provided when a patient is admitted to a hospital inpatient or observation status, or to a nursing facility during an encounter in another setting, consult the "Initial Hospital Inpatient or Observation Care" or "Initial Nursing Facility Care" codes. For procedures or services identified by a CPT code that can be separately reported on the same date, use the relevant CPT code. Be sure to apply the appropriate modifier(s) to indicate separately identifiable evaluation and management services and specify the extent of services provided within a surgical package. If a patient is seen in the emergency department for the convenience of a physician or other qualified healthcare professional, you should use office or other outpatient services codes (99202-99215).

3 Using the Medicare Physician Fee Schedule (MPFS) look-up tool, here are five CPT codes related to the Evaluation and Management Services – Emergency Department Services – New or Established Patient and their respective postoperative periods: 1. 99281 – Emergency Department visit for the evaluation and management of a patient that may not require that presences of a physician or other qualified health care professional – XXX – Free of Global surgical bundling issues 2. 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 – XXX – Free of Global surgical bundling issues 3. 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 – XXX – Free of Global surgical bundling issues 4. 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 – XXX – Free of Global surgical bundling issues 5. 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 – XXX – Free of Global surgical bundling issues The CPT codes listed above are different type of examples of the Evaluation and Management Services – Emergency Department Services – New or Established Patient along with their correct postoperative period. Accurately assigning the correct CPT codes for a debridement procedure and grasping the associated postoperative timeframe are crucial for proper billing and reimbursement. References AMERICAN MEDICAL ASSOCIATION. (2022). Cpt Professional 2023 And E/M Companion 2023 Bundle . AMERICAN MEDICAL ASSOCIAT.

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