cpt 99282

(2022) CPT Code 99282 – Description, Guidelines & Clinical Examples

This article will define CPT Code 99282, explain the medical necessity to report CPT 99282, the guidelines and clinical examples of CPT 99282.

CPT Code 99282 Description

CPT Code 99282 (CPT G0381) is defined by the CPT manual as follows (the text in Italic is the official definition of CPT 99282):

Counselling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient’s and/or family’s needs. Usually, the presenting problem(s) are of moderate severity. Emergency department visit for the evaluation and management of a patient, which requires these 3 key components:

Component 1: An expanded problem focused history

Component 2: An expanded problem focused examination

Component 3: Medical decision making of moderate complexity

Reimbursement Guidelines BCBS

Documentation of the patient’s medical history for emergency department (ED) diagnosis and treatment must include symptoms, diagnoses, and treatment plan in order to get 99282 CPT Code reimbursed.

It must also include a physician’s written order which should be clearly documented in the medical history.

Medical records and itemised bills may be asked for from the care provider to demonstrate the level of care provided.

Medical records are used to determine the scope of the medical history, the scope of the examination performed, the complexity of medical decision making (quantity of diagnoses or treatment choices, amount and / or complexity of data to be reviewed, and risk of complications), and / or morbidity or mortality as well as services provided. This data is verified in relation to the level of care billed and its suitability is evaluated.

If observation services are billed using any of the ED related classification and management codes, the MCG criteria will be used to assess the medical necessity of those observation hours.

Coverage is defined in the terms and restrictions of an individual member’s programs or products and the clinical CPT coding and payment policy criteria set forth below.

The level of performance of a physician or other qualified healthcare professional is defined by the following when using CPT code 99282.

Low Complexity CPT 99282

Consultation and / or coordination of care with other physicians, other qualified health professionals or agencies are provided according to the nature of the problems and the needs of the patient and / or family. Generally, the problems encountered are mild – moderate in severity.

The problems presented are of minor to moderate severity. For example, non-prescription medications or treatments and simple dressing changes. The patient shows understanding fast and easily. ED visit to evaluate and treat a patient requiring these 3 key components:

  • Component 1: An expanded problem-oriented medical history
  • Component 2: An advanced problem-oriented examination
  • Component 3: Low complexity medical decision making

CPT Code 99282 Examples

Example 1

Emergency department visit for a 20-year-old student who presents with a painful sunburn with blister formation on the back.  

Example 2

Emergency department visit for a child presenting with impetigo localised to the face.  

Example 3

Emergency department visit for a patient with a minor traumatic injury of an extremity with localised pain, swelling, and bruising.  

Example 4

Emergency department visit for an otherwise healthy patient whose chief complaint is red, swollen cystic lesion on his/her back.  

Example 5

Emergency department visit for a patient presenting with a rash on both legs after exposure to poison ivy. 

Example 6

Emergency department visit for a young adult patient with infected sclera and purulent discharge from both eyes without pain, visual disturbance, or history of foreign body in either eye.  

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