ACEP Emergency Department Facility Coding – Complete Guide

Introduction

Emergency Department (ED) facility coding is essential for accurate reimbursement and compliance. The American College of Emergency Physicians (ACEP) has developed clear guidelines for assigning ED facility Evaluation & Management (E/M) levels based on the intensity of resources used, not just the physician’s documentation.

This guide covers all ED facility levels – from Level 1 (low complexity) to Critical Care (life-threatening conditions) – so coders, billers, and healthcare administrators can confidently assign the correct code every time.

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ED Facility Coding Levels – Detailed Guides

Click each link to read the full details, interventions, examples, and coding tips:

• Level 1 – CPT 99281 – Minimal complexity, limited interventions, stable patients.

• Level 2 – CPT 99282 – Low complexity, simple workup, few resources.

• Level 3 – CPT 99283 – Moderate complexity, multiple interventions, stable to mildly unstable patients.

• Level 4 – CPT 99284 – High complexity, extensive workup, more intense monitoring.

• Level 5 – CPT 99285 – Highest non-critical complexity, urgent interventions.

• Critical Care – CPT 99291/99292 – Life-threatening conditions requiring constant attention.

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Why Use ACEP Guidelines for Facility Coding?

• Standardization – Ensures consistent coding across providers and facilities.

• Compliance – Reduces risk of audit findings.

• Accurate Reimbursement – Matches resources used with appropriate payment.

• Educational Value – Helps staff understand documentation requirements.

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Best Practices for ED Facility Coding

1. Document Every Intervention – Even if minor, list it to justify the level.

2. Reflect Patient Acuity – Level should match severity and resources used.

3. Use ACEP Examples as Guidance – But rely on your facility’s policy for final coding.

4. Link Physician and Facility Coding – They are separate but should be consistent in complexity.