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!