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Emergency Department Facility Coding

Hospitals should report ED visit levels using CPT codes 99281-99285, and Critical Care codes 99291/99292.

Hospitals, like physicians, code for both procedures and for Evaluation and Management Services (E/M levels).


The introduction of a congressionally mandated Outpatient Prospective Payment System (OPPS), which CMS implemented in August of 2000 using Ambulatory Payment Classifications (APCs). 

You can think of APCs as similar to inpatient DRGs. APCs represent a prospective defined payment for outpatient ED services much like DRGS, which also have a fixed payment. One big difference between DRGs and APCs is that DRG payments are based on diagnosis coding, the diagnosis that is assigned to the patient, (e.g. a complicated pneumonia diagnosis gets a fixed inpatient payment) and APCs are based on CPT procedure coding, what procedures were performed on the patient, (e.g. there is a fixed payment for performing a specific CPT injection code).

Emergency Vehicles

An important thing that APCs and DRGs have in common is that, except in some exceptions, additional payments are not provided outside of the Diagnosis or CPT code submitted, so if the patient stays in the hospital for an extra day the DRG inpatient payment stays the same, or if the medication chosen is expensive the APC outpatient payment for the injection CPT code does not change.


Our ED facility coders are skilled in identifying and assigning appropriate CPT codes for all ED physician and nurse procedures.

We have deep depth knowledge of coding the E/M levels(99281-99285), critical care codes(99291-99292) , IV infusions, the medications supplies and other procedures frequently done in ED facility

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