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2023 Emergency Medicine Coding Guide

Rates level of service required in emergency medicine.

This guide reflects the 2023 AMA CPT Evaluation and Management (E/M) coding changes for Emergency Medicine. Definitions have been simplified and are based on the full coding guideline available here.

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Number and Complexity of Problems

Number and Complexity

a. May require admission/aggressive treatment & care escalation.
b. Threat to life/body function w/out treatment.
c. Chronic problem worse from baseline.
d. Problem is at its baseline.
e. New, serious (not minor) undiagnosed problem.
f. Serious systemic symptoms in associated illness.
g. Extensive injury or impacting multiple body systems, has multiple treatment options, or morbidity.
h. ≥2 problems that are self-limited.
i. Problem is at its baseline.
j. Low risk of morbidity, little-to-no mortality risk.
k. New/recent problem, but stable.
l. Relatively minor problem, but still needing hospital care.
m. Problem that is self-limited.

Risk of Morbidity, Mortality, or Complications

Risk level

High: parenteral controlled substances, elective/emergency major surgery decision, hospitalized considered, or DNR/de-esc considered
Moderate: prescription drug management, minor/major surgery decision, or limited by social DOH
See Evidence for details.

Amount and/or Complexity of Data

Tests ordered

Unique item like a CBC, troponin, CT scan, EKG, etc.

Tests results reviewed (excluding labs)

Review of imaging, EKGs, etc.

Prior external notes reviewed

Outside ED/hospital setting or specialty

Assessment requiring and independent historian

Independent historian: anyone who provides additional information patient can’t provide, does not include interpreters

Independent interpretation of tests

Test interpreted by ER doctor but formal read will be done (and billed for) by another HCP

Discussed management/test interpretation w/external professional

With external physician/other qualified health care professional/appropriate source, not separately reported

Result:

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