99284

🎯 CPT 99284 - Emergency Department Visit (Level 4)

Description & Explanation: Used for patients requiring a medically appropriate history/exam and Moderate level of Medical Decision Making. These patients typically require prescription management, review of multiple diagnostic tests, or have conditions with systemic symptoms.

• MDM Level: Moderate (Level 4).

  • Problems: Moderate complexity (e.g., 1 chronic illness with exacerbation, 2 stable chronic illnesses, 1 undiagnosed new problem with uncertain prognosis, 1 acute illness with systemic symptoms).

  • Data: Moderate (e.g., ordering 3 unique tests, independent interpretation of a test).

  • Risk: Moderate risk (e.g., Prescription drug management, decision for minor surgery with risk factors).

Code Tree:

• Evaluation and Management

  • Emergency Department Services

    • New or Established Patient

      • 99284: Moderate MDM

Technical Data:

• WRVU (2025): ~2.74

• Global Period: XXX

• Assistant Payable: No

• HCC Information: N/A

Clinical Examples:

1. Pneumonia: Patient with fever and cough. CXR shows infiltrate. Labs ordered. Prescribed antibiotics and discharged home or admitted to observation.

2. Kidney Stone: Patient with flank pain. CT scan ordered (positive for stone). Pain managed with IV narcotics (prescription drug management).

3. Closed Fracture: Patient with distal radius fracture. X-rays reviewed. Fracture reduced (procedure billed separately) and splinted. Management of pain and orchestration of orthopedic follow-up.

TABLE WITHOUT ID
  link(file.link, cpt_code) AS "Code",
  short_title AS "Description",
  usage_mdm_level AS "MDM Level",
  wrvu AS "WRVU"
FROM #Emergency_Department
WHERE cpt_code != null
SORT wrvu ASC