ACEP ID:

Urgent Care E/M

1. I am an ED physician, but I also work in an Urgent Care Center; do I need to follow the new CPT E/M guidelines for 2023?

2. How do the new Office or Other Outpatient E/M codes 99202-99215 guidelines differ from the 1995 CMS E/M guidelines?

3. Am I no longer required to document a history or exam?

4. What are the modifications to the criteria for determining Medical Decision Making?

5. How is MDM used to assign Office or Other Outpatient E/M codes 99202-99215?

6. How are the Number and Complexity of Problem(s) Addressed measured?

7. Amount and/or Complexity of Data Reviewed measured?

8. How is the Risk of Complications and/or Morbidity or Mortality measured?

9. How are the rules for coding based on time revised?

10. How much time is required for each E/M code?

11. What if my encounter exceeds the time allotted for 99201 or 99215?

12. What are the codes for prolonged services, and how are they assigned?

13. Do these revisions to the E/M guidelines also apply to the Emergency Department codes 99281 – 99285?

14. Do these guidelines apply to the observation E/M codes also?

15. Where can I find the complete set of guidelines?

Updated February 2024

Disclaimer

The American College of Emergency Physicians (ACEP) has developed the Reimbursement & Coding FAQs and Pearls for informational purposes only.   The FAQs and Pearls have been developed by sources knowledgeable in their fields, reviewed by a committee, and are intended to describe current coding practice. However, ACEP cannot guarantee that the information contained in the FAQs and Pearls is in every respect accurate, complete, or up to date.

The FAQs and Pearls are provided "as is" without warranty of any kind, either express or implied, including but not limited to, the implied warranties of merchantability and fitness for a particular purpose. Payment policies can vary from payer to payer. ACEP, its committee members, authors or editors assume no responsibility for, and expressly disclaim liability for, damages of any kind arising out of or relating to any use, non-use, interpretation of, or reliance on information contained or not contained in the FAQs and Pearls. In no event shall ACEP be liable for direct, indirect, special, incidental, or consequential damages arising out of the use of such information or material. Specific coding or payment related issues should be directed to the payer.

For information about this FAQ/Pearl, or to provide feedback, please contact David A. McKenzie, ACEP Reimbursement Director at (469) 499-0133 or dmckenzie@acep.org.

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