2025 CPT code 99282
(Active) Effective Date: N/A Revision Date: N/A Evaluation and Management - Emergency Department Services Feed
Emergency department visit for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and straightforward medical decision making.
Modifiers can be applied to this code to indicate specific circumstances, such as unrelated E/M services during a postoperative period (modifier 24), significant, separately identifiable E/M services on the same day as a procedure (modifier 25), or multiple outpatient hospital E/M encounters on the same date (modifier 27).
Medical necessity for this code requires that the patient's condition requires immediate medical attention in an emergency department setting.
The provider performs an evaluation and management (E/M) service for a patient in the emergency department. The level of medical decision-making (MDM) involved is straightforward. Elements of MDM include the number and complexity of problems addressed; the amount and/or complexity of data to review and analyze; and the risk of complications, morbidity, and mortality related to patient management. The service also may include taking a patient history and performing a physical examination.
In simple words: The provider sees a patient for an emergency department visit. The visit involves a straightforward level of medical decision-making.
Emergency department visit for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and straightforward medical decision making. The provider determines the nature and extent of the history and/or exam appropriate for the encounter. This service includes a medically appropriate history and/or physical examination, when performed.
Example 1: A patient presents to the emergency department with a laceration on their hand. The provider assesses the wound, cleans it, and sutures it. The MDM is straightforward., A patient presents to the emergency department with a headache. The provider performs a history and physical exam and determines the patient has a tension headache. The MDM is straightforward., A patient presents to the emergency department with abdominal pain. The provider performs a history and physical exam, orders blood work, and determines the patient has gastroenteritis. The MDM is straightforward.
Documentation should include the reason for the visit, relevant history, physical exam findings, medical decision making, and any treatment provided. The documentation must support the level of service billed.
- Revenue Code: M3 (EMERGENCY ROOM VISIT)
- Modifier TC rule: Not applicable
- Specialties:Emergency Medicine
- Place of Service:Emergency Room - Hospital