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Choosing The Code That Best Represents E/M Services

Posted by Aprillice Alvez on Oct 1, 2020 6:59:00 AM

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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!


Topics: Medical Coding

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