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The New Rules of the ED Game


New guidelines from the American Medical Association (AMA) went into effect for emergency department (ED) evaluation and management (E/M) services at the beginning of this year. This is the first time since the 1990s that changes have been made for these services. The new rules will affect 85 percent of ED E/M codes billed by emergency physicians.


Though there are changes in how the services will be documented, CPT codes 99281 through 99285 will remain the same numbers. Keeping them these numbers the same will hopefully eliminate confusion.

Notably, these changes include the elimination of history and physical exam as part of the ED E/M selection. Starting this year, ED E/M services will only be based on medical decision making (MDM). Though history and exam won’t affect the code selected, there should be a medically appropriate history and/or physical exam.


Also, the final diagnosis alone will not determine the E/M code. Diagnosis and therapeutic intervention to identify or eliminate will decide MDM even when high morbidity isn’t the final diagnosis.


Doctors also can get MDM credit for the decision making process whatever the outcome of the diagnosis. This makes support of physician-based decision making more solid.

Emergency medicine remains a highly complex practice and change is always the one constant. For a detailed breakdown of the rule changes from the AMA, go here.


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