EM Coding Alert
Avoid Reporting Prolonged E/M Services in ED
Question: Can we code for prolonged E/M services in the ED? Florida Subscriber Answer: No. You may not report prolonged services codes (99354-99357) with emergency department (ED) evaluation and management (E/M) codes (99281-99285) as these codes do not have an associated time assigned. However, if an ED E/M service becomes "prolonged," you might be able to code it as an observation visit instead, with the following codes, depending upon the encounter specifics: Bottom line: The 99281 (Emergency department visit for the evaluation and management of a patient, which requires these 3 key components: a problem focused history; a problem focused examination; and straightforward medical decision making...) through 99285 (Emergency department visit for the evaluation and management of a patient, which requires these 3 key components within the constraints imposed by the urgency of the patient's clinical condition and/or mental status: a comprehensive history; a comprehensive examination; and medical decision making of high complexity...) codes have no time component, so there is no way to tell if an ED E/M service was "prolonged" beyond the typical level. Without a time element within the ED E/M components, prolonged services are not applicable.
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