Choosing The Code That Best Represents E/M Services

What are E/M Services?

E/M Services stands for Evaluation and Management Services. E/M Services codes refer to the current procedural terminology (CPT) codes that represent the patient-physician encounters. The accuracy of the provided documentation will determine the correct E/M code selection. Total accuracy and precision are vital in choosing the codes to help healthcare providers in their evaluation and treatment plan. Healthcare payers require correct E/M codes to ensure that it is part of the covered services from a patient’s insurance plan. 

E/M guidelines are developed by the Centers for Medicare and Medicaid and the American Medical Association to dictate the documentation for each E/M code. Healthcare providers choose between 1995 and 1997 version of the guidelines in their documentation of an E/M encounter. 

How to Bill for E/M Services?

E/M service billing includes the collection of the CPT code that best reflects the patient type, the location/setting of the encounter, and the level of service provided. It classifies patients as either recent (one who in the last three years has not received any service from a health care provider) or existing (one who in the previous three years has received service from a health care provider). An office or outpatient area, an inpatient hospital, an emergency room, or a nursing home can be the location/setting of the doctor-patient encounter. 

The services of E/M are described in various categories and levels. While experience, physical evaluation, and medical decision-making are the three main components of the E/M services offered, meetings related to therapy and/or continuity of treatment are an exception to this rule. Take note that the greater the complexity of the interaction or encounter, the higher the code level to be used. 

What are the CPT codes for E/M services:

99201-99499        Evaluation and Management Services

99201-99215        Office or Other Outpatient Services

99217-99226        Hospital Observation Services

99221-99239        Hospital Inpatient Services

99241-99255        Consultation Services

99281-99288        Emergency Department Services

99291-99292        Critical Care Services

99304-99318        Nursing Facility Services

99324-99337        Domiciliary, Rest Home (eg, Boarding Home), or Custodial Care Services

99339-99340        Domiciliary, Rest Home, or Home Care Plan Oversight Services

99341-99350        Home Services

99354-99416        Prolonged Services

99366-99368        Case Management Services

99374-99380        Care Plan Oversight Services

99381-99429        Preventive Medicine Services

99441-99449        Non-Face-to-Face Services

99450-99456        Special Evaluation and Management Services

99460-99463        Newborn Care Services

99464-99465        Delivery/Birthing Room Attendance and Resuscitation Services

99466-99486        Inpatient Neonatal Intensive Care Services and Pediatric and Neonatal Critical Care Services

99483-99484        Cognitive Assessment and Care Plan Services

99484-99484        General Behavioral Health Integration Care Management

99487-99490        Care Management Evaluation and Management Services

99492-99494        Psychiatric Collaborative Care Management Services

99495-99496        Transitional Care Evaluation and Management Services

99497-99498        Advance Care Planning Evaluation and Management Services

99499-99499        Other Evaluation and Management Services

How to Determine the Correct E/M Service Codes?

There are three components that should be considered in selecting the correct E/M service code:

• The range of the patient’s medical history. Physicians use their professional experience, clinical judgment, and the existence of the problem(s) raised by the patient to assess the scope of the background required to complete the service. Patient history can be divided into one of four groups, ranging from problem-oriented to comprehensive.
• The extent of the physical examination. Physicians use their professional experience, clinical judgment, and the presented medical problem(s) to assess the type of test required. There are four types of physical tests, ranging from problem-oriented to comprehensive.
• The dynamics of clinical decision-making. The complexity of medical decision-making depends on the number of probable diagnoses or approaches to be considered; the number and/or quantity of patient reports, laboratory reports, and other data that doctors will collect, evaluate and analyze; and the possibility of severe illness, morbidity and/or mortality.

How to Prevent E/M Mistakes and Denials?

Evaluation and Management (E/M) Services claims are often handled by medical billing firms. The key to optimizing payment and minimizing audit risk is correct documentation and coding of E/M patient visits. Here are some ways on how you can prevent E/M Mistakes and Denials:

• Stay informed for guideline updates and changes
• Always follow documentation rules
• Recheck and double-check before submitting you claims
• Ensure services rendered are “reasonable and necessary”
• Provide clear documentation for Level 4 Office Visits
• Choose the code that best represents E/M services provided
• Partner with a trusted medical billing company

What's the Best Medical Billing Company?

DrCatalyst is the best medical billing company. Our end-to-end revenue cycle management services will help increase revenue and reduce medical billing inefficiencies of your practice that hurt your cash flow. You can get a free revenue cycle management check-up with our medical billing experts too! Schedule a free consultation today!

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