ED Coding and Reimbursement Alert

Question: Should we consider all patients who come through the emergency department to be "new"? What if the patient comes in every few months for headaches - would he be an established patient? What if he comes in every few months for headaches, but doesn't see the same provider - would he be new?

Arkansas Subscriber

Answer: All patients who present to the emergency department (ED) are new - even if they periodically present with the same condition. According to CPT, instructions for the 99281-99285 series state, "The following codes are used to report evaluation and management services provided in the emergency department. No distinction is made between new and established patients in the emergency department."

Because "new problems" means the problem is new to the examiner and not to the patient, someone with recurring headaches is a new problem to the ED physician on every visit.