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.
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.
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
There are three components that should be considered in selecting the correct E/M service code:
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:
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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DrCatalyst | All Rights Reserved.