200–350 patients a day, real-time E/M level decisions, and critical care documentation that has to hold up under audit months later. We know every code, every modifier, and every downcoding trap.
Common Billing Challenges
These are the six billing failure points we see most often in ED groups — and the ones our team resolves systematically from day one.
ED E/M codes (99281–99285) run on the older 3-component MDM structure. Missing one pillar on a Level 5 visit gets it downcoded to 99284 — we document all three before submission.
99291/99292 replaces the ED E/M code, it doesn't stack with it. We verify organ-system impairment, total time, and separately-billed procedure carve-outs before the claim goes out.
The Two-Midnight Rule decides billing type, not bed assignment. We track admit/discharge timing against CMS rules so same-day and multi-day observation stays code correctly.
Since 2023, physician billing requires the physician to personally document the substantive portion of a PA/NP-shared visit — not just co-sign. We catch the mismatch before a payer audit does.
Laceration repair, fracture splinting, and airway procedures are separately billable from the E/M visit — and frequently missed when nursing-performed work isn't linked to a physician order.
ED charts get written under clinical pressure, in volume, in real time. We build structured templates that capture billing-supportive detail without slowing down the shift.
Key Procedure Codes
Our coders hold emergency medicine-specific credentials and train continuously on the codes that drive the most revenue — and the most denials — in the ED.
| CPT Code | Description | Common Issue |
|---|---|---|
| 99285 | ED E/M, Level 5, high complexity | Requires all 3 MDM pillars documented |
| 99291 | Critical care, first 30–74 minutes | Bills instead of, not in addition to, ED E/M |
| 99235 | Same-date observation admit/discharge | Most common observation code, moderate MDM |
| 12001–12007 | Simple laceration repair | Modifier 59 required same-date as E/M |
| 31500 | Emergency endotracheal intubation | Separately billable; subtract from critical care time |
| 25600 | Fracture management, distal radius | Not billable separately if splint-only, no manipulation |
Why Rcmaxis
We're not a generalist billing service that added a specialty module. Our team is built around the pace and audit exposure of ED billing.
Every coder on your account holds emergency medicine coding credentials — not a generic CPC only.
Significantly above the 12.6% industry denial rate for emergency medicine. Fewer rejections means faster payment and less write-off risk.
High-volume ED charge capture turned around in 24–48 hours, with level assignment and critical care flags reviewed before the claim goes out.
One point of contact who knows your group, your payers, and your billing history — available for weekly calls and monthly performance reviews.
Month-to-month engagement. We earn your business every month by improving your collections — not by locking you in.
Live visibility into your collections, denial rate, aging AR, and payer performance — updated daily, reviewed monthly with your account team.
Straight answers to what ED groups usually ask before they switch.
Free revenue assessment for qualified practices. We audit your last 90 days of claims, identify every revenue leak, and show you a clear path to better collections — at no cost.