Overview
CPT 99285 is used for Emergency Department visits involving a comprehensive history, comprehensive examination, and medical decision-making of high complexity. These cases often require extensive diagnostic work-up, multiple high-resource interventions, and prolonged physician involvement.
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Type A: APC 616
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Type B: APC 630
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HCPCS: G0384
Possible Interventions
Could include interventions from previous levels, plus any of:
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IV thrombolytics administration
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Blood transfusion
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Central line insertion or assistance
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Intubation preparation or assistance
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Chest tube placement preparation or assistance
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Arterial line placement
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Preparation for emergent surgery
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Preparation for complex imaging (e.g., CT angiography, interventional radiology)
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Administration of multiple IV medications with titration
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Multiple complex lab tests with serial measurements
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Extended observation (>2 hours)
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Continuous cardiac and hemodynamic monitoring
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Preparation for transfer to higher-level care facility
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Multiple discharge instructions with high-complexity counseling
Potential Symptoms/Examples Which Support the Interventions
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Acute myocardial infarction
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Stroke with thrombolytic therapy consideration
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Severe respiratory distress requiring advanced airway management
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Major trauma with multiple system involvement
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GI bleed with hemodynamic instability
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Sepsis requiring aggressive fluid resuscitation and antibiotics
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Altered mental status requiring extensive work-up
Key Notes for Coders
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Level 5 requires high complexity in all three key components: history, exam, and decision-making.
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Documentation must justify resource intensity and clinical severity.
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If the patient’s condition meets the criteria for life-threatening organ dysfunction requiring constant attention, code Critical Care (99291/99292).
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