What is CPT® 99284?
CPT® 99284 is reported for an emergency department (ED) visit that requires a detailed history, detailed examination, and medical decision-making of moderate complexity. It applies to patients who present with problems of high severity, but who do not pose an immediate, significant threat to life or physiologic function.
When to Use CPT® 99284
This code is appropriate for conditions that demand urgent evaluation and treatment, but are not immediately life-threatening. Examples include:
- New-onset chest pain without ECG changes
- Complex fractures requiring splinting
- Severe asthma attacks with good response to treatment
- Abdominal pain with suspected appendicitis (pending further imaging)
Key Components for Billing
- History: Detailed
- Exam: Detailed
- Medical Decision-Making: Moderate complexity
- Patient Status: Applicable to both new and established patients
- Typical Time: Not time-based; determined by documentation of components and clinical complexity
Documentation Requirements
To support CPT® 99284, the patient’s chart must include:
- Thorough documentation of history and physical findings
- Differential diagnoses and rationale for work-up
- Diagnostic tests ordered and interpretation
- Evidence of clinical judgment in managing moderate to high-risk conditions
- Patient education and disposition plan
Why It Matters
Correctly coding for CPT® 99284 is essential for compliance and revenue integrity, especially in emergency settings where the complexity of care can vary widely. Proper documentation reduces audit risk and ensures timely reimbursement.
How OptiMantra Helps
With OptiMantra’s intelligent charting system, providers can streamline emergency and urgent care workflows:
- Customizable charting templates tailored for ED and urgent care visits
- Manual coding selection supported by integrated billing tools
- Integrated superbill generation to prevent missed charges
- Automated claim submission to simplify revenue cycle management
OptiMantra ensures that every ED visit, from moderate to critical care, is documented accurately and billed correctly, giving providers more time to focus on patient care.
Try OptiMantra for free here!
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