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Emergency Department Visits

Definition

Emergency department (ED) services are E/M services provided to patients in the Emergency Department.

Explanation

These services may be billed by any specialty physician, not just Emergency Department physicians. The physician does not need to be assigned to the ED. However, these codes may only be used in a hospital-based facility that is available 24 hours/day for unscheduled care to patients who present for immediate medical attention.

Codes

99281, 99282, 99283, 99284, 99285 – Emergency Department Visits

Coverage

AmbulanceMost insurers will pay for services provided in an Emergency Department, however many payers will deny claims if they believe the patient’s condition did not require emergency care. These are diagnosis related denials. Some states have a Prudent Lay Person Law. If a prudent lay person believes that the condition is an emergency, the insurance company is required to cover it.

A physician called to the ED in consultation to see a Medicare fee-for-service patient should bill an ED visit if the patient is discharged from the hospital. For inpatient and observation services, see the chart here.

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Last revised June 28, 2021 - Betsy Nicoletti
Tags: category of service

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Our mission is to provide accurate, comprehensive, up-to-date coding information, allowing medical practices to increase revenue, decrease coding denials and reduce compliance risk. That's what coding knowledge can do.

In 1988, CodingIntel.com founder Betsy Nicoletti started a Medical Services Organization for a rural hospital, supporting physician practice. She has been a self-employed consultant since 1998. She estimates that in the last 20 years her audience members number over 28,400 at in person events and webinars. She has had 2,500 meetings with clinical providers and reviewed over 43,000 medical notes. She knows what questions need answers and developed this resource to answer those questions. For more about Betsy visit www.betsynicoletti.com.

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