EMERGENCY DEPARTMENT CHARGE SHEET REFERENCE GUIDE

FACILITY CHARGES

LEVEL 5 99285

-Patients with Admission or Transfer to a higher level of care

-Any patient with 3 or more diagnostic tests such as:

Cardiac Workup/ Abdominal Pain Workup- Labs, EKG, CXR

Septic Workup- Blood,urine, x-ray

-Any patient that receives IV Contrast for CT

Any case involving extensive facility resources- ex: non-resourced patient with legal order of protection
with CT evaluation or coordination of referrals to hospital and clinic services

Uncontrolled diabetes

Infections that receive IM or IV antibiotics

Respiratory with three or more neb treatments

Any extremity with potential vascular compromise

Evaluation for major musculoskeletal injury such as spinal column with multiple imaging

Level 4 99284

Patients with two or more interventions

Chest pain with EKG only and chest xray only, no blood testing

Pts with multiple plain xrays and no CT examination

Pts with two breathing treatments, no other meds, no other diagnostic testing

Complicated discharge instructions with no workup in house-example referral to follow up with eye
doctor as an outpatient

Level 3

Pts with plain xrays of only 1 area

Discharge with an RX- no other interventions

Rapid strep or flu test only, no other interventions

Level 2
No rx is given

Well baby exam/ wound checks without interventions

Ace wrap or sling, no other interventions

Sunburn/ rash/ uri/ viral complaints with no RX

Level 1

ER recheck

Suture removal

Note to return to work with no interventions

Rx refill, not psych, no abnormal vital signs