Targeted Probe and Educate audits are currently focused on emergency department CPT codes 99283, 92284 and 99285. The timing is right to review the documentation requirements.

When you examine patients in the emergency department, be sure to assign the correct family of codes with place of service 23. The correct code depends not on whether the patient is new or established to you, but on the patient’s location during the exam.

The exam code family is 99281-99285. To choose the level of exam, you must meet all three components listed below:

99281

• A problem-focused history; and
• A problem-focused examination; and
• Straightforward medical decision making.

The problem(s) are self-limited or minor.

99282

• An expanded problem-focused history; and
• An expanded problem-focused examination; and
• Medical decision making of low complexity.

The problem(s) are of low to moderate severity.

99283

• An expanded problem-focused history; and
• An expanded problem-focused examination; and
• Medical decision making of moderate complexity.

The problem(s) are of moderate severity.

99284

• A detailed history; and
• A detailed examination; and
• Medical decision making of moderate complexity.

The problem(s) are of high severity and require urgent evaluation.

99285

• A comprehensive history; and
• A comprehensive examination; and
• Medical decision making of high complexity.

The problem(s) are of high severity and likely pose an immediate significant threat to life or physiologic function.

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