Emergency departments are built for chaos. But billing them? That should be precise.

Since 2023, ED Evaluation & Management (E/M) services are leveled based solely on Medical Decision Making (MDM) — not history, not exam, not word count. And yet, many claims still reflect outdated habits, vague documentation, or inflated complexity.

If you’re not reviewing ED levels with surgical precision, you’re not just overpaying — you’re reinforcing a system that rewards ambiguity.

What Changed — and Why It Matters

• Pre-2023: ED E/M levels were based on three components — history, exam, and MDM
• Post-2023: Only MDM determines the level (99281–99285)
• MDM is scored across three dimensions:
  • Number and complexity of problems addressed
  • Amount and/or complexity of data reviewed
  • Risk of complications or morbidity from management

> Translation: It’s not about how much is documented — it’s about what was actually done, decided, and risked.

Where the Waste Creeps In

• Level 4 and 5 ED visits are now the norm — not the exception — in many systems
• Upcoding risk is high when documentation is templated or AI-generated
• False positives in audits waste time and erode trust
• Payers often lack the clinical insight to challenge levels without triggering appeals

And here’s the kicker: ED visits are short, high-volume, and high-cost — making them the perfect storm for unnoticed inflation.

What We Do Differently

We don’t just audit ED levels. We decode the logic behind them.

• We review MDM alignment — not just code selection
• We flag pattern-based inflation (e.g., every visit is a 99285)
• We understand how risk is being interpreted — and when it’s being stretched
• We help payers build prepayment review strategies that are fast, fair, and focused

This isn’t about denying care. It’s about paying for the care that was actually delivered — no more, no less.

Final Word: ED Leveling Isn’t Broken — But It’s Being Bent

Emergency medicine is complex. But billing for it shouldn’t be. If you’re still relying on volume-based review or post-payment audits, you’re missing the moment to lead.

Let’s bring clarity to the chaos — and set a new standard for what ED integrity looks like.

This is Off Script. We don’t just level claims. We level expectations.