99285

🎯 CPT 99285 - Emergency Department Visit (Level 5)

Description & Explanation: The highest level of ED E/M service (short of Critical Care). Used for patients requiring a medically appropriate history/exam and High level of Medical Decision Making. These patients typically have conditions that pose a threat to life or bodily function.

• MDM Level: High (Level 5).

  • Problems: High complexity (e.g., 1 acute or chronic illness or injury that poses a threat to life or bodily function).

  • Data: Extensive (e.g., ordering/reviewing 3+ unique tests plus independent historian, etc.).

  • Risk: High risk (e.g., Decision regarding hospitalization, drug therapy requiring intensive monitoring, decision for emergency major surgery, decision to de-escalate care).

Code Tree:

• Evaluation and Management

  • Emergency Department Services

    • New or Established Patient

      • 99285: High MDM

Technical Data:

• WRVU (2025): ~4.00

• Global Period: XXX

• Assistant Payable: No

• HCC Information: N/A

Clinical Examples:

1. Acute MI: Patient with chest pain. ECG shows ischemia (but not STEMI requiring critical care time). Labs, CXR, Heparin/Aspirin started. Admitted for cardiology.

2. Sepsis: Elderly patient with fever, hypotension (responsive to fluids), and UTI. Lactate elevated. Broad-spectrum IV antibiotics started. Admitted.

3. Stroke Alert: Patient with acute weakness. CT head negative. TPA considered but not given. Admitted for neurology workup.

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