Policy / Article-005
E/M Emergency Department Services Educational Guide
- Effective Date: 01/01/2026
- Reviewed/Revised Date: 03/23/2026
- Next Review Date: 03/23/2027
- Origination Date: 01/01/2026
-
Originated Department:
Correct Coding Integrity
Audience
This resource sheet applies to professionals involved in emergency department E/M services.
- CPT 2026 Professional Edition, AMA
- AMA CPT Assistant, ED guidance
- CMS Evaluation & Management Services Guide
- Official ICD-10-CM / CPT coding rules
Clinical Providers
✓ Physicians
✓ Nurse Practitioners (NPs)
✓ PAs working in ED
Coding & Billing Professionals
✓ Medical Coders
✓ Clinical Documentation Improvement (CDI) specialists
✓ Compliance and audit personnel
Overview
Evaluation and management services are provided in an Emergency department setting for patients requiring urgent or emergent evaluation, typically for acute illness or injury.
- ED services are time and MDM-based.
- CPT codes for ED services reflect the severity of the patient’s condition and the complexity of care.
- Documentation must support medical necessity, MDM, and the level of service.
1. Always document acuity and complexity of the ED patient
2. Include data reviewed (labs, imaging, outside records, consults)
3. Specify risk to the patient to support code selection
4. Document interventions and disposition
5. Ensure clarity by avoiding vague statements like “patient evaluated” without detail
Common Audit Triggers
- Missing chief complaint or history
- Vague exam documentation
- Ambiguous MDM justification
- Incomplete documentation of interventions or disposition
For each ED encounter, documentation should include:
✓ Chief Complaint / Reason for Visit – concise and specific
✓ History of Present Illness (HPI) – describe onset, severity, progression
✓ Past Medical History / Medications / Allergies – relevant to the acute problem
✓ Physical Examination – problem-focused or extended based on patient acuity
✓ Medical Decision Making (MDM)
- Number & complexity of problems
- Data reviewed, ordered, interpreted
- Risk of morbidity or complications
✓ Assessment & Plan / Interventions:
- Diagnoses, procedures, treatment plan
- Disposition (admit, discharge, observation)
✓ Time / Counseling Documentation – If total time is used for code selection, document start/end times, activities, counseling, care coordination
Total 45 min:
20 min direct patient care,
15 min reviewing labs & imaging,
10 min counseling patient/family regarding discharge instructions and follow-up care.
CPT 2026 E/M Codes & Typical Time
Pro Tip
CPT 99281–99285 are level-determined by MDM or total time, not by setting alone.
CPT Code
Setting
Typical Time on Date of Service
MDM Level
Notes
99281
ED
15 min
Minimal
Minor problem, low complexity
99282
ED
25 min
Low
Low-moderate complexity, straightforward
99283
ED
35 min
Moderate
Moderate severity, multiple diagnoses, moderate MDM
99284
ED
50 min
High
High severity, high complexity, potentially life-threatening
99285
ED
70 min
High
Critical problem, very high risk, intensive MDM
Emergency Department Medical Decision Making (MDM)
Pro Tip
ED documentation should highlight acuity, risk, and interventions performed. See documentation checklist ➔
Component
Minimal
Low
Moderate
High
Number/Complexity of Problems
1 minor
2 minor / 1 stable chronic
Multiple stable chronic or acute
Life-threatening / severe acute
Amount & Complexity of Data
Minimal
Limited (labs/imaging)
Moderate (labs, imaging, outside records, consults)
Extensive, multiple sources, highrisk interpretation
Risk of Complications / Morbidity
Minimal
Low
Moderate
High – immediate threat to life or organ function
Revision History
01/01/2026
Correct Coding Integrity
03/23/2026
Revised by Mountain Health CO-OP Policy Committee
Disclaimer
This document is for informational purposes only. It should not replace clinical judgment or provide medical advice. Coverage, benefits, and eligibility are determined by the member’s benefit plan. CPT codes and procedures included are for informational purposes only and do not guarantee reimbursement. © CPT Only – American Medical Association