ED Coding and Reimbursement Alert

Question: What are the rules around reporting cognitive assessment code 99483? We are confused about the reporting requirements.

New Mexico Subscriber

Answer: Although most providers can report 99483 (Assessment of and care planning for a patient with cognitive impairment, requiring an independent historian, in the office or other outpatient, home or domiciliary or rest home, with all of the following required elements: …) for a multidimensional assessment that includes cognition, function, and safety, the reality is that this may not be an option in the ED. CPT^® includes a list of codes with which code 99483 may not be reported, but the ED and observation codes are not included in that list. Of note, CPT^® also lists the typical face-to-face time with the patient is 50 minutes, which may not be realistic in the ED setting.

Therefore, you may not be able to report this code, and therefore you should find an alternative code to report based on the documentation in the record.