Noridian is initiating a service specific targeted review for CPT ® 99285 - Emergency department visit for the evaluation and management of a patient, which requires these 3 key components within the constraints imposed by the urgency of the patient's clinical condition and/or mental status: A comprehensive history; A comprehensive examination; and Medical decision making of high complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, 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 high severity and pose an immediate significant threat to life of physiologic function. This will affect all states/territories with the following CPT ® 99285. Noridian Part B Medical Review has analyzed national and local data to identify atypical billing.
Last Updated Mar 22, 2016