# ER E/M Level



## KaylaRieken (Apr 30, 2019)

I have a hard time in choosing between 99283 and 99284. Physician dictated a comprehensive HPI, Exam, and MDM is Moderate- New problem (Renal Mass, concerning for renal cell carcinoma) Data: Reviewed labs and CT and Risk: Moderate (patient is being scheduled for a radical nephrectomy next week)


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## KaylaRieken (May 30, 2019)

Does anyone have any tips on choosing between 99283 and 99284? I had another one where they dictated comprehensive HPI, Exam, and had MDM as Moderate. It was a new problem (Kidney stone with hydronephrosis and they decided to take the patient to surgery that day). When I read the description in the book for the 99284 it reads Usually, the presenting problems are of high severity, and require urgent evaluation by the physician. When I read urgent evaluation it makes me second guess myself.


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## prem_ponnuru (Jun 13, 2019)

HI,

There is no difference between a new problem and an established problem. In emergency room all problems are considered as new problems. Just for your information.

Thanks,

Prem


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## michellepilcher (Jun 13, 2019)

To bill an E/M in the Emergency Dept you must meet three of three requirements.  A 99285 has a comprehensive history, comprehensive exam and high/complex medical decision making.  If the provider documented a comprehensive history, comprehensive exam and moderate MDM, that leaves you with 99284  (detailed, detailed, moderate).


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## Rmann77 (Feb 20, 2020)

Are you billing for the Physician or the Facility?


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## fwnewbie (May 7, 2020)

Rmann77 said:


> Are you billing for the Physician or the Facility?


Wish I had found this discussion sooner!!  I am trying to learn ED Facility coding but can't figure out what I'm supposed to evaluate.  It seems like the "3 requirements" have more to do with physician coding than facility.  Is facility based on resources used? Nursing time?  Ancillary services time? Procedures? Pt. disposition?  Where can I find some written material to read?


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## twizzle (May 8, 2020)

Yes, ER facility coding for E/M is completely different to physician ER coding. You are correct, it is based around resources used.

Go to acep.org (American College of Emergency Physicians) where you can find a guide to ER facility coding. It is an excellent resource.


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## fwnewbie (May 8, 2020)

Thank you for the info.  I just couldn't figure out why an Outpatient Coder would be expected to use the ED E/M to code facility charges.  After all, isn't a COC a facility coder??
The COC online course doesn't give the guidelines in the printed material - wonder why not?


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## xoposho (Sep 22, 2020)

Hello, I was just looking at the acep.org but couldn't find anything close to ER facility coding and the search button didn't work. Can you help me with navigating please?


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## fwnewbie (Sep 30, 2020)

Sorry for the delay but to tell the truth I don't remember how I found it either.  As far as Practicode goes, the acep.org guidelines are not used for Practicode.  The only way I've gotten the ER guidelines is to copy the rationale given with the case.  Even then, they don't always tell you what level to assign which I find extremely frustrating so it's been very difficult for to accurately assign the EM levels,  Not much of a learning experience for me so far.


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