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CPT Code 99281: Overview


Code: 99281
Description: Emergency department visit for the evaluation and management of a patient, which requires a problem-focused history and examination, and straightforward medical decision making.
Context: This code is used for relatively minor conditions treated in the emergency department (ED). It represents the lowest level of care for emergency department services, typically involving cases that require a brief and straightforward evaluation.

Guidelines for Proper Use:

  • Specific Use for Minor ED Visits: Apply 99281 for emergency department visits that involve a problem-focused history and examination with straightforward medical decision-making. This is generally reserved for less complex cases.
  • Documentation of Visit Elements: Ensure healthcare providers’ documentation includes a problem-focused history and examination, and details of the straightforward medical decision-making process.
  • Exclusion of More Complex Cases: Do not use 99281 for more complicated or time-consuming ED visits that require a more extensive evaluation or complex decision-making. Higher-level ED visit codes are available for such scenarios.
  • Applicability Across Various ED Presentations: This code can be used for a wide range of minor conditions presenting in the emergency department.
  • Compliance with Emergency Department Protocols: Use 99281 in accordance with standard emergency medicine guidelines and protocols, as well as payer-specific rules.

Common Misuses of 99281:

  • Using for More Complex ED Visits: Misuse occurs if 99281 is applied to emergency department visits that are more complex and involve more than straightforward decision-making or a problem-focused exam.
  • Inadequate Documentation: Not providing sufficient detail about the nature of the problem-focused exam and straightforward medical decision-making can lead to misuse of this code.

Incorrect Use in Non-ED Settings: This code is specific to services rendered in an emergency department and should not be used for visits in other clinical settings.

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