CPT 99284: Emergency Department Visit - Moderate Complexity
CPT 99284 reports an emergency department (ED) evaluation and management service for a new or established patient requiring moderate-complexity MDM.
2023+ Criteria (MDM or Time)
| Element | 99284 Requirement |
|---|
| MDM | Moderate complexity: 1+ chronic illness with exacerbation, or 2+ stable chronic, or acute complicated injury; moderate data (review 2–3 categories, independent historian); moderate risk (prescription management, minor surgery) |
| Time | Not used for ED codes (99281–99285 are MDM-only). Note: 99291 critical care uses time. |
Typical 99284 Presentations
- Asthma/COPD exacerbation responding to ED therapy
- Dehydration requiring IV fluids + monitoring
- Uncomplicated pyelonephritis, cellulitis, diverticulitis
- Minor head injury with brief LOC, normal CT
- Chest pain ruled out for ACS (negative troponins, non-ischemic ECG)
- Renal colic with controlled pain
Documentation Essentials
- History: HPI (4+ elements), ROS (2–9), PFSH (1)
- Exam: Expanded problem-focused (2–7 systems)
- MDM: Explicitly list diagnoses, data reviewed, risk rationale
- Disposition: Admit, observation, discharge with follow-up
Common Pitfalls
- Downcoding to 99283 if MDM not clearly moderate
- Upcoding to 99285 without high-complexity justification
- Using time (invalid for 99281–99285)
- Missing independent historian documentation (for pediatric/elderly)
Modifier 25
Not applicable—ED E/M codes are per encounter; procedures billed separately.
Accurate MDM documentation is the sole driver for 99284.
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