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Office/Outpatient E/M Codes

2021 e/m office/outpatient visit cpt codes.

The tables below highlight the changes to the office/outpatient E/M code descriptors effective in 2021.

More details about these office/outpatient E/M changes can be found at CPT® Evaluation and Management (E/M) Office or Other Outpatient (99202-99215) and Prolonged Services (99354, 99355, 99356, 99XXX) Code and Guideline Changes.

All specific references to CPT codes and descriptions are © 2023 American Medical Association. All rights reserved. CPT and CodeManager are registered trademarks of the American Medical Association.

Download the Office E/M Coding Changes Guide (PDF)

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e&m visit codes

Super Administrator

Written By Shelly Cronin (Super Administrator)

Updated at March 27th, 2023

Table of Contents

Evaluation and management (E/M) coding is the use of CPT ® codes from the range 99202-99499 to represent services provided by a physician or other qualified healthcare professional. As the name E/M indicates, these medical codes apply to visits and services that involve evaluating and managing patient health.

Examples of E/M services include office visits, hospital visits, home services, and preventive medicine services. Codes for services like surgeries and radiologic imaging are found outside of the E/M section of the CPT ® code set.

Medicare, Medicaid, and other third-party payers accept E/M codes on claims that physicians and other qualified healthcare professionals submit to request reimbursement for their professional services. E/M service codes also may be used to bill for outpatient facility services. Facilities and practices may use E/M codes internally, as well, to assist with tracking and analyzing the services they provide.

E/M services are high-volume services. Even small E/M coding mistakes can cause major compliance and payment issues if the errors are repeated on a large number of claims. To ensure accurate reporting and reimbursement for these services, those involved in the coding process need to stay up to date on E/M coding rules. An important area to watch is that the Centers for Medicare & Medicaid Services (CMS) and the American Medical Association (AMA) implemented major changes for office/outpatient E/M coding and documentation rules in 2021, and experts expect other E/M sections will see similar changes in the future.

What a Typical E/M Code Looks Like

CPT ® is an abbreviation for Current Procedural Terminology, a set of five-character medical codes maintained by the AMA. Evaluation and Management Services is one section in the CPT ® code set. Other sections in the CPT ® code set include Anesthesia, Surgery, Radiology Procedures, Pathology and Laboratory Procedures, and Medicine Services and Procedures.

CPT ® includes more than two dozen categories of E/M codes , from office and other outpatient services to advance care planning. You may find further divisions within each category, such as separate options for new patients and established patients.

The CPT ® code set uses the same basic format to describe the E/M service levels for many (but not all) categories:

  • A unique code, such as 99235
  • The place and/or type of service, such as observation or inpatient hospital care
  • The service’s content, such as a comprehensive history, a comprehensive examination, and medical decision making (MDM) of moderate complexity
  • The nature of the presenting problem or problems usually associated with a given level, such as moderate severity; and
  • The time usually associated with the service, such as 50 minutes at the bedside and on the patient’s hospital floor

When you bring that all together, it looks like this example code with the official descriptor shown in italics: 99235 Observation or inpatient hospital care, for the evaluation and management of a patient including admission and discharge on the same date, which requires these 3 key components: A comprehensive history; A comprehensive examination; and Medical decision making of moderate complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient’s and/or family’s needs. Usually the presenting problem(s) requiring admission are of moderate severity. Typically, 50 minutes are spent at the bedside and on the patient’s hospital floor or unit.

As noted above, CPT ® revised office and other outpatient E/M codes 99202-99215 in 2021. Most of those codes’ descriptors now follow a template of listing the setting, whether the patient is new or established, the level of medical decision making, and the total time spent on the encounter date. An example is 99213 Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and low level of medical decision making. When using time for code selection, 20-29 minutes of total time is spent on the date of the encounter .

CPT ® and Medicare E/M Documentation Guidelines

E/M coding can be difficult because of the factors involved in selecting the correct code. For example, many E/M codes require the coder to determine the type of history, examination, and medical decision making, which can involve using special grids and tables to check requirements.

The AMA CPT ® code set includes E/M guidelines, but CMS has also published more specific guidance on proper E/M coding and documentation. Most notably, CMS issued the 1995 E/M Documentation Guidelines and the 1997 Documentation Guidelines to help providers and medical coders distinguish the various E/M service levels. Both the 1995 and 1997 E/M Documentation guidelines from CMS are still in use. Many third-party payers also apply these guidelines.

This article references CPT ® E/M section guidelines and CMS 1995 and 1997 Documentation Guidelines because all are important to proper coding of E/M services. Note, however, that because of the 2021 updates to office/outpatient E/M coding, the 1995 and 1997 Documentation Guidelines no longer apply to CPT ® codes 99202-99215.

Commonly Used E/M Terms

When you’re reviewing E/M rules and regulations, you’ll see certain terms frequently. Below are definitions to help you understand E/M terminology.

A qualified healthcare professional is “an individual who is qualified by education, training, licensure/regulation (when applicable), and facility privileging (when applicable) who performs a professional service within his or her scope of practice and independently reports that professional service,” according to CPT ® guidelines. E/M code descriptors and rules often refer to “physicians and other qualified health care professionals.” This may include advanced practice nurses (APNs) and physician assistants (PAs). Clinical staff members do not fall in this category.

A clinical staff member is “a person who works under the supervision of a physician or other qualified health care professional, and who is allowed by law, regulation, and facility policy to perform or assist in the performance of a specific professional service, but does not individually report that professional service,” CPT ® guidelines state.

A professional service is a face-to-face service by a physician or other qualified healthcare professional who can report E/M codes. This definition of a professional service is specific to E/M coding for distinguishing between new and established patients.

A new patient is a patient who has not received any professional services (remember, that means face-to-face services) within the past three years from the physician or qualified healthcare professional providing the current E/M service, or from another physician or qualified healthcare professional of the same specialty and subspecialty who is part of the same group practice. That’s the definition of new patient according to AMA CPT ® E/M guidelines. Medicare refers only to the same physician specialty (not subspecialty) in its definition of new patient for E/M coding, available in Medicare Claims Processing Manual , Chapter 12 , Section 30.6.7.A. Physicians self-designate their Medicare specialty when they enroll, choosing from the list of specialty codes in Medicare Claims Processing Manual , Chapter 26 , Section 10.8.2.

  • The following is an example of a new patient E/M visit demonstrating the professional services rule: A 65-year-old male sees a cardiologist for an E/M service. Another cardiologist in the practice provided an interpretation of an EKG for the same patient the previous year when he was in the emergency department, but there was no face-to-face service. In this case, the cardiologist providing the E/M can still consider the patient to be new for E/M coding purposes because no cardiologist in the practice provided the patient with a face-to-face service within the past three years.
  • The following is an example of a new patient E/M visit demonstrating the same-specialty rule: A patient has been seeing an internist in a multispecialty group for the past three years for primary care, particularly hypertension. The internist identified some suspicious lesions and sent the patient to a general surgeon in the same practice to evaluate lesion removal. The patient is a new patient to the general surgeon because the surgeon has a different specialty than the internist.

An established patient is a patient who has received professional (face-to-face) services within the past three years from the physician or qualified healthcare professional providing the E/M, or from another physician or qualified healthcare professional of the same specialty (and subspecialty, says AMA) who is part of the same group practice.

  • following is an example of an established patient E/M visit demonstrating the same-subspecialty rule: A pediatric patient comes to an office complaining of stomach pains. Although this is the pediatric gastroenterologist’s first time meeting the patient, another doctor of the same subspecialty in the same group practice saw the patient two years ago for a similar complaint. In this case, you should consider the patient to be established.

Scenarios for determining whether a patient is new or established can get complicated. The CPT ® guidelines provide this additional guidance:

  • When a physician or qualified healthcare professional is on-call or covering for another provider, CPT ® guidelines instruct you to classify the patient encounter as new or established based on the patient’s relationship to the unavailable provider.
  • When an APN or PA works with a physician, the CPT ® E/M guidelines state you should consider the APN or PA to be the same specialty and subspecialty as the physician.
  • If your practice has multiple locations and a provider in location A sees the patient in year one and then a same-subspecialty physician at location B sees the patient in year two, consider the patient to be established. The different location is not a factor in determining whether the patient is new or established.

The definitions of new patient and established patient for E/M coding are dense because there are so many elements involved. The decision tree below will help you determine whether a patient is new or established for an E/M encounter. The term QHP used in the graphic stands for qualified healthcare professional.

E/M Decision Tree: New vs. Established Patient

New-vs.-Established-Patient-E/M-Decision-Tree

Components of E/M Service Levels

There are often three to five E/M service levels within each E/M code category or subcategory. Each level has its own E/M code. The intent behind the different levels of E/M services is to represent the variations in skills, knowledge, and work required for different encounters.

There are seven components used in the descriptors of many E/M codes, according to the CPT ® E/M guidelines section “Guidelines for Hospital Observation, Hospital Inpatient, Consultations, Emergency Department, Nursing Facility, Domiciliary, Rest Home, or Custodial Care, and Home E/M Services.” The first three are called key components for E/M level selection.

  • 2. Examination
  • 3. Medical decision making (MDM)

The next three elements are called contributory factors. The first two are important, but they aren’t required or relevant for every encounter.

  • 4. Counseling
  • 5. Coordination of care
  • 6. Nature of presenting problem

There is one final component for E/M services, which you may use to determine the appropriate code level.

The time component does not apply to all E/M codes. For instance, you should not consider time to be a component for emergency department (ED) E/M services. Most ED services are provided in a setting where multiple patients are seen during the same time period, and it would be difficult to calculate time for any one patient. You can read more about the time component of E/M later in this article.

The component requirements for two E/M codes that are the same level may not be the same, so review each descriptor carefully before you make your final code choice.

Table 1 provides an example of how the E/M component requirements may vary between two codes even when those codes are both level-1 codes.

Table 1: Comparison of E/M Component Requirements for 99221 and 99231

For office and other outpatient E/M services 99202-99205 and 99212-99215, your code choice is not based on the seven components listed above. Instead, you make your code choice based only on the MDM level or the total time. Office and outpatient encounters are still likely to include some or all of the other components, however, and the provider should document the encounter completely, even for components that do not drive code selection.

Number of Key Components Required for E/M Code

When selecting E/M code level based on the three key components of history, exam, and MDM , pay attention to whether the code requires you to meet the stated levels for three out of three or two out of three key components.

As an example, in Table 1 you saw that initial hospital visit code 99221 requires all three components, but subsequent hospital visit code 99231 requires only two of the three components. Many of the codes requiring three of three components are for new patients or initial services, and many of the codes requiring two of three components are for established patients and subsequent services.

You must meet or exceed requirements stated in the code descriptor for three out of three key components for the types of E/M codes listed below:

  • Initial observation services
  • Initial hospital inpatient care services
  • Observation/inpatient hospital care that includes admission and discharge services on the same date
  • Office consultation services
  • Inpatient consultation services
  • Emergency department services
  • Initial and certain other nursing facility services
  • New patient domiciliary, rest home (e.g., boarding home), or custodial care services
  • New patient home services

You need to meet requirements for only two out of the three key components for these E/M services:

  • Subsequent observation care
  • Subsequent hospital care
  • Subsequent nursing facility care
  • Established patient domiciliary, rest home (e.g., boarding home), or custodial care services
  • Established patient home services

Many of these E/M codes also include an option to select the level based on time in certain circumstances. You’ll learn more about coding E/M based on time later in this article.

Examples of E/M Coding Based on Key Components

Below are examples of meeting three of three and two of three key components for E/M coding. Remember that the key components for E/M coding are history, exam, and MDM. There are different types (levels) of each component, and a quick look at these types will help you understand the examples.

These are the four types of history in E/M coding, from lowest to highest:

  • Problem focused
  • Expanded problem focused
  • Comprehensive

CPT ® E/M guidelines list four types of examination, as well. The terms used for exam type are the same as those used for history type:

There are also four types of MDM, shown here from lowest to highest:

  • Straightforward
  • Low complexity
  • Moderate complexity
  • High complexity

Let’s start with an example of a new patient rest home visit. For new patient rest home visit E/M codes that require you to meet or exceed three out of three key components (99324-99328), you have to code based on the lowest level component from the encounter.

Suppose a visit included a comprehensive history, an expanded problem focused exam, and MDM of moderate complexity. You must choose your code based on the lowest documented component because you have to meet (or exceed) the requirements for all three components. The lowest component in our example is the expanded problem focused exam, as shown below in Table 2.

Table 2: New Patient Rest Home E/M Example

The correct code in this case is 99325 Domiciliary or rest home visit for the evaluation and management of a new patient, which requires these 3 key components: An expanded problem focused history; An expanded problem focused examination; Medical decision making of low complexity … . The visit exceeded the 99325 requirements for the history and MDM components, and it met the required level for the exam.

If the physician had documented a medically necessary comprehensive exam, this example would have met the requirements to report this same visit using higher-level E/M code 99327 … A comprehensive history; A comprehensive examination; Medical decision making of moderate complexity … . Payers reimburse providers more for higher level E/M codes than for lower ones, so capturing the correct code is essential to accurate payment.

For established patient rest home visit codes that require you to meet or exceed two of three key components (99334-99337), you should disregard the lowest level component and code based on the next lowest requirement met.

Suppose an established patient E/M rest home visit included a detailed interval history, an expanded problem focused exam, and medical decision making of high complexity. The lowest requirement met was the expanded problem focused exam. You should disregard this requirement because the code descriptors state you need to meet only two of three key components to report a code. The next lowest level met was a detailed interval history. Table 3 shows the components for this visit, with the lowest level component crossed out because you can disregard that component when you select your code.

Table 3: Established Patient Rest Home E/M Example

For this scenario, you should use 99336 … requires at least 2 of these 3 key components: A detailed interval history; A detailed examination; Medical decision making of moderate complexity … , assuming that there was medical necessity for this level of an established patient visit. The encounter meets the history requirement and exceeds the MDM requirement. The visit doesn’t meet 99336’s requirement of a detailed exam, but that does not prevent you from reporting this code. You need to meet or exceed only two of the three components to choose this established patient code, and you did that with the history and MDM.

You may have noticed the term “medical necessity” in the examples. Medical necessity is an overriding factor when coding E/M. Even if a provider documents enough information to check all the boxes for a higher level of service, the claim should not include a higher-level code if the medical necessity supports only a lower-level code.

Nature of Presenting Problem in E/M Coding

The nature of the presenting problem is a contributory factor, rather than a key component, for your E/M code choice, according to the CPT ® E/M guidelines section “Guidelines for Hospital Observation, Hospital Inpatient, Consultations, Emergency Department, Nursing Facility, Domiciliary, Rest Home, or Custodial Care, and Home E/M Services.” But the presenting problem is still an important element to understand. The nature of the presenting problem carries weight when determining the medical necessity of an E/M service.

A presenting problem is the reason for the encounter, as described by the patient. Examples include an illness, injury, symptom, finding, or complaint. Many E/M code descriptors reference the presenting problem by using one of the five types described below.

Minimal means the problem is one for which the physician or other qualified healthcare professional may not need to be present in the room. An example would be a nurse working under the supervision of the billing provider to perform a follow-up service and suture removal for a simple repair of a superficial wound.

Self-limited or minor refers to a problem that is expected to have a definite course and is temporary. This level problem is unlikely to alter the patient’s health status permanently. An insect bite is a possible example.

Low severity problems have a low risk of morbidity (disease/medical problems) and little or no risk of death even with no treatment. The patient should be able to recover from this level of problem without functional impairment. Depending on the case, sinusitis may be an example.

Moderate severity problems have a moderate risk of morbidity or death without treatment. The prognosis is uncertain or extended functional impairment is likely. Some cardiac events may fit this category.

High severity problems have a high to extreme risk of morbidity without treatment. The risk of death with no treatment is moderate to high, or severe, extended functional impairment is highly likely. Sepsis may fit this level.

As an example, the descriptor for the highest-level emergency department E/M code, 99285, states, “Usually, the presenting problem(s) are of high severity and pose an immediate significant threat to life or physiologic function.”

Definition of Time for Office/Outpatient E/M

For E/M coding, the definitions and roles of “time” differ depending on the category. Coders and providers need to be aware of these differences to ensure proper documentation and coding. The Time section of the E/M guidelines explains rules for various types of E/M codes, including office and outpatient E/M codes 99202-99205 and 99212-99215. The main point for these codes is that you may use the total time spent on the date of the encounter to determine which code applies.

Total time combines the face-to-face and non-face-to-face time the provider spends on the encounter on the encounter date. As a result, the total time may include tasks like reviewing tests before the patient is present or coordinating care after the patient leaves, as well as the time required for the visit. Clinical staff time is not counted in total time.

The descriptors for office and outpatient codes 99202-99205 and 99212-99215 each include a time range specific to that code. For instance, the descriptor for 99213 states, “When using time for code selection, 20-29 minutes of total time is spent on the date of the encounter.” As that wording indicates, as long as the total time falls within the listed range, it is appropriate to choose 99213. (As noted earlier, coding for these services may be based either on total time or on MDM level.)

Definition of Time for Non-Office E/M Codes

Unlike the office and outpatient codes, many of the other CPT ® E/M code descriptors include the amount of time “typically” spent on that level of service. The times identified in those CPT ® code descriptors are averages, so that the single number shown (such as 30 minutes) represents a range. An individual encounter may have a time that is longer or shorter than the time in the code descriptor, depending on the clinical circumstances.

Providers may use the time listed in the code descriptor, rather than the key components, to choose the appropriate E/M service level, but only when counseling and coordination of care dominate the visit. The next section provides more information about that process.

The times listed in the non-office E/M descriptors are intraservice times, not total times. Intraservice time is either face-to-face time or unit/floor time depending on the type of service.

Use face-to-face time for these E/M services:

  • Outpatient consultations: 99241-99245
  • Domiciliary, rest home, custodial services: 99324-99328, 99334-99337
  • Home services: 99341-99345, 99347-99350
  • Cognitive assessment and care plan services: 99483

Face-to-face time is the time that the provider spends face-to-face with the patient and/or family, including time the provider uses to get a history, perform an examination, and counsel the patient. The provider likely also spends time pre- and post-encounter on reviewing records and tests, arranging further services, or other activities related to the visit. This time is not included in the intraservice time listed in the E/M code descriptor, but payers are aware of the total work involved and can use that as a factor when setting rates.

Use unit/floor time for these E/M services:

  • Hospital observation services: 99218-99220, 99224-99226, 99234-99236
  • Hospital inpatient services: 99221-99223, 99231-99233
  • Inpatient consultations: 99251-99255
  • Nursing facility services: 99304-99310, 99315, 99316, 99318

Unit/floor time is the time that the provider is present on the patient’s facility unit and at the bedside providing services for the patient. You should factor in time the provider spends on the unit or at the bedside creating or reviewing the patient’s chart, examining the patient, writing notes, and communicating with other professionals and the patient’s family.

Using Time to Choose a Non-Office E/M Code

For office and outpatient codes 99202-99205 and 99212-99215, code selection is based on either total time or MDM. If the total time falls in the range in the code descriptor, you may report that code for the encounter. For other E/M codes that include time in their descriptors, coding based on time is more complicated.

In some cases, using time to select a non-office E/M code may result in a higher-level code than using history, exam, and MDM . But you should only use time as the controlling factor in your non-office E/M code selection when counseling, coordination of care, or both make up more than 50% of the face-to-face time with the patient or family or more than 50% of the floor/unit time, depending on the nature of the service.

Counseling is a discussion with the patient, family, or both that covers at least one of the following, according to CPT ® E/M guidelines:

  • Diagnostic results, impressions, or diagnostic studies recommended for the patient
  • The patient’s prognosis
  • Treatment options’ risks and benefits
  • Instructions regarding treatment or follow-up
  • Reasons why complying with the selected treatment or management options is important
  • How to reduce risk factors
  • Education for the patient and family

For this E/M coding based on time, “family” includes those who are responsible for patient care or decision-making, such as foster parents or a legal guardian. But pay attention to payer rules, which may differ from CPT ® guidelines, such as requiring the counseling and care coordination to occur in the patient’s presence.

To support this type of E/M reporting based on time, documentation should include the “extent” of counseling and/or coordination of care, according to CPT ® E/M guidelines. The 1995 and 1997 Documentation Guidelines expand on this, stating the provider should document the total length of time of the encounter and the counseling or activities performed to coordinate care. The documentation also will need to show that the encounter exceeded the 50% threshold for time spent on counseling, coordination of care, or both.

In a best-case scenario, documentation of time for an E/M visit should include the following to determine if the counseling and care coordination accounted for more than half the time:

  • The beginning and ending time of the counseling and/or coordination of care
  • The beginning and ending time for the overall face-to-face or floor/unit service.

The provider also should include the components of history, exam, and MDM — even if cursory — in the documentation. Good medical record keeping requires that the provider document pertinent information. Using time as the determining factor to choose the E/M level does not change that documentation requirement.

Consider this example of coding based on time: A surgeon and patient spend 20 minutes of a 25-minute subsequent inpatient visit discussing test results and treatment options for colon cancer. The surgeon summarizes the discussion in the medical record. The history, exam, and MDM are minimal in this case, but because counseling dominates the encounter, you can use time as the controlling factor when assigning the E/M service level. You should code the visit as 99232 … Typically, 25 minutes are spent at the bedside and on the patient’s hospital floor or unit … based on the 25 minutes documented for the total visit and the percentage of time spent on counseling.

For complete information about reporting E/M based on time, you should check with individual payers to learn if they require you to meet the time stated in the code descriptor or if they allow you to round up to the closest reference time.

If the E/M codes you are choosing from have no reference time, you can’t use time as a controlling factor when determining the appropriate service level.

What Is Not Included in E/M Codes

Along with knowing the components that affect E/M code selection, you need to know what not to include in an E/M code:

  • You may separately report performance and interpretation of diagnostic tests and studies ordered during the E/M service, assuming documentation meets those codes’ requirements for separate reporting.
  • The separate E/M can be prompted by the same symptoms or condition (diagnosis) the provider performed the other procedure or service for, but documentation must show that the E/M meets the requirements of the appropriate E/M code’s definition. In other words, you should not count work performed for the other procedure or service when you are determining the E/M code level.
  • You should append the appropriate modifier to the E/M code to show it meets requirements for separate reporting, such as modifier 25 Significant, separately identifiable evaluation and management service by the same physician or other qualified health care professional on the same day of the procedure or other service .

Unlisted E/M Services and Special Reports

Two final basic E/M concepts you should know are unlisted services and special reports.

An unlisted E/M service is an E/M service that the CPT ® code set does not identify with a specific code. You should report these services using 99429 Unlisted preventive medicine service and 99499 Unlisted evaluation and management service . When you report these codes, the AMA’s CPT ® guidelines for E/M state you should use a “special report” to describe the service.

A special report is documentation that demonstrates the medical appropriateness of an unlisted service or a service that is new, is not usual, or may vary. In other words, the special report shows why a patient needed a particular service that doesn’t have a unique code, which may help support payment for the claim.

The report should include a clear description of the “nature, extent, and need for the procedure and the time, effort, and equipment necessary to provide the service,” the CPT ® E/M guidelines state. Noting if the symptoms were particularly complex, what the final diagnosis was, relevant physical findings, procedures performed to diagnose or treat the patient, concurrent problems, and follow-up care also may help show medical necessity for the service.

For special reports that you are sending to payers, experts advise using plain language so that reviewers can understand what happened and why, even if they aren’t experts in the type of case involved.

E/M Code Categories

Last Reviewed on June 11, 2022 by AAPC Thought Leadership Team

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Evaluation & Management Visits

This page contains guidance regarding documentation and payment under the Medicare Physician Fee Schedule for evaluation and management (E/M) visits.

  • 1995 Documentation Guidelines For Evaluation and Management Services (PDF)
  • 1997 Documentation Guidelines For Evaluation and Management Services (PDF)
  • CY 2019 PFS Proposed Rule Documentation Requirements and Payment for Evaluation and Management Visits and Advancing Virtual Care (PDF)
  • Physician Fee Schedule (PFS) Payment for Office/Outpatient Evaluation and Management (E/M) Visits – Fact Sheet (PDF) - Updated 01/14/2021
  • Evaluation and Management (E/M) Visit Frequently Asked Questions (FAQs) (PDF)
  • Evaluation and Management Services MLN Publication
  • FAQs: Split (or Shared) Visits and Critical Care Services (PDF) :  Posted 4/7/2022
  • (877) 266-9040

e&m visit codes

Evaluation & Management (E/M) Codes Cheat Sheet

Financial losses loom large for physicians across the country due to costly oversights in their billing for evaluation and management (E&M) codes. The monetary differences between the visit levels and respective charges are high causing a significant loss, especially for independent and small practices. To avoid these costly oversights, it is important to be aware of recent changes in the E/M visit reporting. AMA has issued CPT Guidelines for E/M Code changes effective from Jan 2023 introducing several new components to the way E/M visits are coded, including consideration of the Medical decision-making (MDM) and the time factor, which allows leveling E&M level along with prolonged service reporting. 2021’s Social determinants of health (SDOH) are still operative in E/M coding. It is imperative to understand these new components in order to accurately report visits and prevent potential costly financial losses.

Medical Decision-Making in E&M

One of the most common billing mistakes is the inability to document the complexity of the patient’s case. When this crucial factor is not accurately reflected in the coding, the service provided is not adequately compensated. Equally damaging is the lack of documentation concerning elements of patient history and physical exams, which can also lead to reduced payment for services rendered. Medical decision-making (MDM) is an activity to make decisions based on levels of complexity. MDM is a decision-support methodology that provides a systematic way of organizing, processing, and recording clinical information vital to improved healthcare delivery. MDM captures and analyzes vital signs, history, and physical examination data with clinical assessment findings during patient encounters or on separate evaluation and management consults. MDM is based on a three-tier structure consisting of – i. Problem identification, ii. Data (test) review, and iii. Risk of complications. To determine the appropriate E&M visit, two out of three elements must match the same level. Level-II visit involves straightforward MDM and Level-III visit contain low-complexity MDM with a problem-focused exam of the affected body area plus one symptomatic related area. The applicable code for a level-II visit is 99212 which earns around $37.14, while level-III visit code 99213 fetches around $59.50, making a huge difference in your monthly revenue. When you apply level II even if you are eligible to use level III, you are actually leaving money on the table. You can use the table below to determine the correct E/M code:-

e&m visit codes

Selection in the above highlighted example: The appropriate MDM level would be moderate, as two of the three elements of medical decision-making were met in that category.

MDM grid has also embraced the time factor to help identify appropriate E/M visit levels. Time is not only used to determine the E/M visit level, but it also plays a role in determining if a service should be considered prolonged or not. Physician or other qualified health care professional time includes the following activities:

  • Prepping to see the patient (e.g., review of tests)
  • Obtaining and/or reviewing a patient history
  • Conducting and evaluating medical examination
  • Counselling and educating the patient/family/caregiver
  • Ordering medications, tests, or procedures
  • Referring to and communicating with other health care professionals (when not separately reported)
  • Documenting clinical information in the electronic or other health records
  • Independently interpreting results (not separately reported) and communicating results to the patient/family/caregiver
  • Care coordination (not separately reported

Note:- Travel time cannot be included. By understanding how time plays a role in coding for an E/M visit, physicians can ensure that they are accurately billing for their services.

e&m visit codes

Prolonged Service Code

In order to bill for services beyond the allocated time in the above table, specific codes have been designated. The AMA uses the lowest value of time as a reference, while the CMS use the highest value of time as a reference. Thus, CPT code 99417 was created for AMA and distinct HCPCS codes G2212 and G0318 were formed for CMS. Consultation codes are not accepted in CMS. Additionally, AMA only considers the length of time spent on the date of the service, while CMS considers 3 days prior or 7 days after the service.

e&m visit codes

Social Determinants of Health

Social determinants of health (SDOH) like- availability of resources, job opportunities, exposure to violence, extreme poverty, and financial insecurity limit the diagnosis and treatment procedure. Including SDOH (code Z55-Z65) as a secondary diagnosis is helpful to accurately present the patient’s condition and altered treatment plan to insurance companies.

Understanding the nuances of E/M coding is essential for physicians to accurately bill for services rendered and to ensure they receive fair compensation for their hard work. If this seems too arduous and byzantine, book a call with our expert to take the load off your shoulders.

e&m visit codes

Priyanka Rana

MBA in Finance & International Business, Masters in English Literature

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Decoding Coding: Tips and Resources for the Young Ophthalmologist

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Congratulations! You worked hard during residency and fellowship to build a solid foundation of knowledge and clinical and surgical skills. 

Now as you transition to practice, it is important not only to use what you have spent so many years mastering but also how to be fairly compensated for your work.

I’ll review introductory concepts in ophthalmic coding and provide resources from the Academy’s practice management affiliate, the American Academy of Ophthalmic Executives ® (AAOE ® ), to get you started.

I’d encourage you to take a deeper dive in your chosen subspeciality since these are the codes and concepts you will use daily. Remember, don’t code inappropriately; code only for the work you perform. 

ICD-10-CM Codes

The International Classification of Disease, Tenth Revision (ICD-10) is a diagnostic coding system used for claims processing. Here are some tips to help out:

Be specific. Avoid unspecified laterality, as there are codes corresponding to a particular diagnosis affecting the right eye, right upper eyelid, both eyes, etc.

Avoid what is just “possible.” If you haven’t yet confirmed the diagnosis, it is better to code for the sign or symptom that is present.

Understand the seventh character. The seventh character of the code can refer to the timing of treatment, especially for trauma:

A- Initial: This character describes encounters where the patient is receiving active treatment for the specified diagnosis. For example, if you see a hyphema patient daily during the initial week, these are still initial encounters.

D- Subsequent: This character describes patients who are followed in the recovery phase once active treatment is completed. If you see that same hyphema patient six months later to check their intraocular pressures, this would be a subsequent encounter.

S-  Sequelae: This character is used when complications arise from the original diagnosis. A separate code corresponding to the complication will typically follow the original diagnosis that now includes the specified “S” seventh character. Now your hyphema patient has developed a retinal detachment. You would code for the RD and, if you suspect the trauma led to the detachment, you can bill this code as sequelae.

The seventh character can also indicate stage in glaucoma diagnosis. Not all glaucoma codes require staging. If both eyes have the same stage, select the bilateral code and indicate the stage as the seventh character. If the ICD-10-CM code has no laterality indicator, code for the stage of the most severely affected eye.

The A (an initial encounter), D (a subsequent encounter) and S (for sequela) characters apply to injury and trauma codes. D is used for encounters after the physician performs the initial treatment. S is not typically submitted for medical claims. 

For more information see:

ICD-10-CM for Ophthalmology: Complete Reference

ICD-10-CM Decision Trees and Quick Reference Guides

E/M vs. Eye Codes

Ophthalmologists have two options for outpatient visits — eye visit or evaluation and management (E/M) codes.  

Eye Visit Codes (920XX)

These codes include both new (9200X) and established (9201X) patients with two types of visits to choose from — comprehensive and intermediate. Both visit types require a history, general medical observation, and chief complaint be documented, as well as the impression/plan with regards to initiating or continuing a diagnosis and treatment. They differ in the exam. 

A comprehensive exam includes a complete examination of the visual system — all 12 elements as listed in the resources below. The intermediate exam includes at least 3 but less than 12 of these elements that are deemed medically necessary. Most payers expect to see, and the Academy recommends, dilation for comprehensive eye​ visit codes unless medically contraindicated.  

For more information see the Eye Visit Code Checklist .

E/M Codes (992XX)

They include both new (9920X) and established (9921X) patients and are based on: 1) medical decision-making (MDM) or 2) total physician time to select the appropriate code level. This is where you may have heard terms such as “Level 3” or “Level 4” applied to an office visit. 

Medical decision-making has three components: problem, data and risk. Each has defined levels of complexity. Two of the three components must have the same level of complexity to determine the final level of exam. A level 4 E/M (99204/14) does not equate to a comprehensive eye visit code (92004/14).

What to Choose: Eye or E/M Code? 

This is a common question. Fortunately, AAOE has many resources to help determine when an eye or E/M code is most appropriate. Keep in mind, E/M codes are also used for inpatient/emergency department visits, whereas eye visit Codes are not.

How to Choose Between E/M and Eye Visit Codes

MDM Table Office Visit  

MDM Table Inpatient/ED Visit

Simplifying Coding: 5 Steps to Choosing the Right E/M or Eye Visit Code

Current Procedural Terminology (CPT) is a coding system used for claims processing.  You will use CPT codes for procedural services you render. A list of CPT codes is available in print and as a pocket guide. 

Academy Ophthalmic Coding Coach

CPT Professional Edition

CPT: Complete Pocket Ophthalmic Reference

Modifiers can be added to procedural or visit codes. Proper modifier use

ensures that the services billed by the physician are paid for correctly. Missing or incorrect use of a modifier(s) is one of the top five reasons payers reject insurance claims. 

There are many modifiers, so it is important to have a comprehensive understanding of their definitions and how to use them properly. The resources we have listed below are some common exam or surgery modifiers, but it’s not a comprehensive list. Some of the most important modifiers are: -24, -25, -57 .

Effectively Use Exam Modifiers

Coding Resources by Topic

Further Resources

Codequest™

AAOE offers courses in ophthalmic coding including, in person and virtual classes often held in collaboration with state ophthalmology societies in multiple cities across the U.S. They cover coding updates and review key competencies. There is also a wealth of coding resources and guidance in the Practice Management section of the Academy website, including these web pages:

  • The Top Rules of Ophthalmic Coding  
  • Virtual Fundamentals of Ophthalmic Coding
  • Coding Tips for the Newly Graduated Ophthalmologist

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Evan Silverstein, MD — Chair Sruthi Arepalli, MD Grayson W. Armstrong, MD Liane O. Dallalzadeh, MD Cherie A. Fathy, MD Bradley S. Henriksen, MD L. Claire Peterson, FRCOphth, MBBS Dagny C. Zhu, MD 

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Care delivery organizations billing a minimum of 50 e-visits in each quarter. CPT indicates Current Procedural Terminology .

Data Sharing Statement

  • Billing Patient Portal Messages as e-Visits and Patient Messaging Volume JAMA Research Letter January 24, 2023 This study evaluates the adoption of clinician billing for patient portal messages as e-visits, prompted by significant increases in patient messaging after the onset of the COVID-19 pandemic. A. Jay Holmgren, PhD, MHI; Maria E. Byron, MD; Carrie K. Grouse, MD; Julia Adler-Milstein, PhD

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Holmgren AJ , Oakes AH , Miller A , Adler-Milstein J , Mehrotra A. National Trends in Billing Secure Messages as E-Visits. JAMA. 2024;331(6):526–529. doi:10.1001/jama.2023.26584

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National Trends in Billing Secure Messages as E-Visits

  • 1 Division of Clinical Informatics and Digital Transformation, University of California, San Francisco
  • 2 Trilliant Health, Brentwood, Tennessee
  • 3 Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
  • Research Letter Billing Patient Portal Messages as e-Visits and Patient Messaging Volume A. Jay Holmgren, PhD, MHI; Maria E. Byron, MD; Carrie K. Grouse, MD; Julia Adler-Milstein, PhD JAMA

At the onset of the COVID-19 pandemic, the Centers for Medicare & Medicaid Services (CMS) and other payers broadly expanded telemedicine reimbursement, including for e-visits. E-visits are asynchronous patient messages requiring medical decision-making and at least 5 minutes of clinician time over 7 days, with patient consent for billing. 1 Many health systems have begun billing for e-visits to increase revenue and compensate clinicians for responding to the increasing number of patient-initiated messages. 2 - 4 This practice has generated controversy given that patients are unsure which messages will trigger a bill and concerns that billing may discourage messaging. 5 It is unclear how many e-visits are being billed, how many organizations are billing e-visits, and what clinical conditions are being billed. To inform health system decision-making on e-visits as well as the policy debate on uptake and spending, this study assessed trends in e-visit billing using national all-payer claims data.

We used the Trilliant Health 6 all-payer claims database, which includes Medicaid, Medicare Advantage, private payer, and traditional Medicare claims representing patients from all 50 states and the District of Columbia. The data are ingested from CMS, commercial payers, and clearinghouses and are aggregated and cleaned, date back to 2017, and include a mean of 272 509 331 unique individuals with at least 1 claim in a given year. We identified claims for e-visit Current Procedural Terminology ( CPT ) codes (99421-99423) from January 2020 to September 2022. We measured e-visit claims, in total, by CPT code, and as a proportion of all evaluation and management (E&M) visits monthly, as well as the number and proportion of unique organizations (determined by type 2 National Provider Identifier [NPI] and address where service was rendered) billing at least 50 e-visits in each quarter to identify organizations regularly billing for e-visits and exclude those with very few e-visits or accidental claims. In addition, we identified the 10 most common associated diagnosis codes for each CPT code. Analyses were conducted using Databricks version 13.3 LTS. This study was deemed exempt from review by the University of California, San Francisco, institutional review board.

There were a mean of 103 127 e-visit claims per month in 2020 (0.2% of all E&M visits), 77 164 in 2021 (0.1%), and 100 541 in 2022 (0.1%; Figure ). Claims peaked in April 2020 (202 272 claims), fell to a post-COVID low in June 2021 (64 341), and rebounded to 107 442 in September 2022. Over the study period, the most common CPT codes were 99421 (5-10 minutes; 44.8%) and 99422 (11-20 minutes; 40.4%), followed by 99423 (≥21 minutes; 14.8%). In the third quarter of 2022, 471 unique organizations (0.5% of all organizations) billed at least 50 e-visits, an increase of 39.8% compared with the same period in 2021.

The most common diagnoses associated with CPT code 99421 were acute sinusitis (7.1%), urinary tract infection (7.0%), and acute respiratory infection (4.5%). For code 99422, they were acute respiratory infection (4.2%), acute sinusitis (4.1%), and hypertension (3.8%; Table ). E-visits for CPT code 99423 were most commonly associated with diagnoses for hypertension (18.0%).

Billing for e-visits peaked at the onset of the pandemic, fell, and then rebounded slowly, whereas the number of organizations billing e-visits has increased since mid-2021. Together these findings suggest health system interest in e-visit billing has evolved from a short-term pandemic necessity to a potential long-term source of revenue. E-visit claims for shorter periods were largely for acute diagnoses such as sinusitis or urinary tract infection, whereas longer e-visits were more often associated with chronic conditions including hypertension. This variation may suggest that shorter, lower-cost messages may substitute for synchronous acute care, whereas longer, more complex messaging is more often an additional care touch point.

This study has limitations, including inability to assess what proportion of messages were billed to assess intensity of e-visit billing relative to patient message volume. Future research is needed to understand whether e-visits are cost-effective, improve patient health, or substitute for synchronous visits, and what drives organizations to start and stop billing for them.

Accepted for Publication: December 5, 2023.

Published Online: January 10, 2024. doi:10.1001/jama.2023.26584

Corresponding Author: A Jay Holmgren, PhD, MHI, University of California, San Francisco, 10 Koret Way, Office 327A, San Francisco, CA 94131 ( [email protected] ).

Author Contributions: Dr Oakes and Mr Miller had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: Holmgren, Oakes, Adler-Milstein, Mehrotra.

Acquisition, analysis, or interpretation of data: Holmgren, Oakes, Miller.

Drafting of the manuscript: Holmgren.

Critical review of the manuscript for important intellectual content: All authors.

Statistical analysis: Oakes, Miller.

Administrative, technical, or material support: Holmgren, Mehrotra.

Supervision: Holmgren, Oakes.

Conflict of Interest Disclosures: Dr Holmgren reported receiving grants from the American Medical Association, Healthcare Leadership Council, and Office of the National Coordinator for Health IT outside the submitted work. Dr Adler-Milstein reported receiving nonfinancial support from Augmedix outside the submitted work. Dr Mehrotra reported receiving consulting fees from Sanofi, Black Opal Ventures, and the Pew Charitable Trust. No other disclosures were reported.

Data Sharing Statement: See the Supplement .

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E/M office visit coding series: Tips for time-based coding

Series overview:

  • How to code visits in one or two questions
  • Tips for time-based coding 
  • Problems are the coding key 
  • Code the visit by just looking at your assessment and plan 

The 2021 E/M office visit coding changes allow physicians to code visits based solely on total time, which is defined as the entire time you spent caring for the patient on the date of the visit. It includes your time before the visit reviewing the chart, the actual face-to-face visit with the patient, and all the time you spend after the visit on documentation, reviewing studies, calling the patient or family, etc. — as long as you do it before midnight on the date of service. It does not include time you spend on other dates, time you spend doing procedures that are separately billed, or time your nurses or other staff spend.

For established patients, it may be helpful to remember what I call the “30/40 minute rule”: Level 4 visits start at 30 minutes, and level 5 visits start at 40 minutes. (For more time-based coding tips, see this previous “Getting Paid” post .)

Documentation tips

Documentation is important if you are going to base your coding on time. Rather than just writing “Total time spent was XX minutes,” it’s useful to explain what was included in the time, especially now that patients have access to your notes. They may not understand that the time you’ve listed includes more than just the face-to-face portion of the visit. Here’s an example of a well-explained note: “ Total time spent caring for the patient today was XX minutes. This includes time spent before the visit reviewing the chart, time spent during the visit, and time spent after the visit on documentation, etc.”

A little extra explanation may also be useful in case of an audit. For example, if you did a procedure during a visit and billed for it separately, you might want to add, “ Time excludes procedure time ” just to make sure there’s no confusion about that.

Take care with EHR time calculators

EHR time calculators that document the time a patient’s chart is open can be helpful if you’re using time for coding. But relying on them too much can cause problems. If you don’t remember to open the chart as soon as you enter the room and keep it open for the entire visit, it’s not going to accurately reflect the time you actually spent. If you can access the chart by smartphone as well as computer, make sure your EHR tracks time on both devices or, again, you will have an undercount.

Over-reliance on time calculators could also cause you to overstate your total time if your EHR double-counts time when the chart is open in your office and in the exam room simultaneously, or if it falsely counts time when the patient’s chart is tabbed but not opened.

Long visits (prolonged services)

Unfortunately, depending on the payer, there are currently different prolonged services codes, with different time ranges, for visits that exceed level 5 in total time. Medicare and some private insurance companies use G2212, which is for established patient visits of 69 minutes or more and new patient visits of 89 minutes or more. Other insurers use CPT code 99417, which is for established patient visits of 55 minutes or more and new patient visits of 75 minutes or more. With both codes, prolonged services are billed in 15-minute increments and pay 0.6 work Relative Value Units for each 15 minutes. Below is a chart you can quickly reference for time-based coding, including prolonged services.

— Keith W. Millette, MD, FAAFP, RPH

Posted on Oct. 31, 2022

  • Chronic care
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  • Physician compensation
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Disclaimer: The opinions and views expressed here are those of the authors and do not necessarily represent or reflect the opinions and views of the American Academy of Family Physicians. This blog is not intended to provide medical, financial, or legal advice. Some payers may not agree with the advice given. This is not a substitute for current CPT and ICD-9 manuals and payer policies. All comments are moderated and will be removed if they violate our Terms of Use .

Copyright © 2024 American Academy of Family Physicians. All Rights Reserved.

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  4. Evaluation & Management (E/M) Codes Cheat Sheet

    e&m visit codes

  5. The 2023 Hospital and Nursing Home E/M Visit Coding Changes

    e&m visit codes

  6. New E/M Coding Guidelines for Optometrists

    e&m visit codes

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  1. E&M GUIDELINES AND PRACTICE QUESTIONS PART-4 || MEDICAL CODING

  2. Initial Consult Visit Codes

  3. Why would a hospital system not allow cystoscopies in the office? E&M visit in an ASC

  4. Sliderule Mini

  5. Evaluation & Management codes / Office visit, Preventive visit, Emergency visit procedure codes

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  1. Evaluation and Management Coding, E/M Codes

    Evaluation and management (E/M) coding is the use of CPT ® codes from the range 99202-99499 to represent services provided by a physician or other qualified healthcare professional. As the name E/M indicates, these medical codes apply to visits and services that involve evaluating and managing patient health.

  2. Outpatient E/M Coding Simplified

    Prolonged visit codes cannot be used with the shorter E/M levels, i.e., 99202-99204 and 99212-99214. (See "Prolonged services " tables.) Clinicians should consult with individual payers to ...

  3. PDF CPT® Evaluation and Management (E/M) Code and Guideline Changes

    The basic format of codes with levels of E/M services based on medical decision making (MDM) or time is the same. First, a unique code number is listed. Second, the place and/or type of service is specified (eg, office or other outpatient visit). Third, the content of the service is defined. Fourth, time is specified.

  4. Office/Outpatient E/M Codes

    2021 E/M Office/Outpatient Visit CPT Codes. Office or other outpatient visit for the evaluation and management of a new patient, which requires these 3 key components: A problem focused history; A problem focused examination; Straightforward medical decision making. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided ...

  5. E/M coding for outpatient services

    To report an office or other outpatient visit for a new patient, you'll choose from E/M codes 99201-99205. As this article mentioned previously, office/outpatient visits include history, clinical examination, and medical decision-making (MDM) as the three key components for code selection. To determine which E/M code from 99201-99205 is ...

  6. Coding for Evaluation and Management Services

    Total time on the date of the encounter may be used alone to select the appropriate code level for the following E/M services: Office visit services (CPT codes 99202-99205, 99211-99215)

  7. A Step-by-Step Time-Saving Approach to Coding Office Visits

    The new rules for coding evaluation and management (E/M) office visits are a big improvement but still a lot to digest. 1, 2 To ease the transition, previous FPM articles have laid out the new ...

  8. PDF MLN906764 Evaluation and Management Services Guide 2023-08

    Split (or Shared) E/M Services. CPT Codes 99202-99205, 99212-99215, 99221-99223, 99231-99239, 99281-99285, & 99291-99292. A split (or shared) service is an E/M visit where both a physician and NPP in the same group each personally perform part of a visit that each 1 could otherwise bill if provided by only 1 of them.

  9. PDF MLN906764 Evaluation and Management Services Guide 2022-06

    This guide is intended to educate providers about the general principles of evaluation and management (E/M) documentation, common sets of codes used to bill for E/M services, and E/M services providers. This guide is offered as a reference tool and does not replace content found in the 1995 Documentation Guidelines for Evaluation and Management ...

  10. CPT®️ E&M Codes

    Evaluation and management (E/M) coding and billing are crucial to maintaining the efficiency and productivity of a medical practice today. E&M coding involves use of CPT codes ranging from 99202 to 99499. These represent services by a physician (or other health care professional) in which the provider is either evaluating or managing a patient's health. Procedures such as diagnostic tests ...

  11. E/M Coding

    Evaluation and management (E/M) coding is the use of CPT ® codes from the range 99202-99499 to represent services provided by a physician or other qualified healthcare professional. As the name E/M indicates, these medical codes apply to visits and services that involve evaluating and managing patient health.

  12. Evaluation & Management Visits

    1997 Documentation Guidelines For Evaluation and Management Services (PDF) CY 2019 PFS Proposed Rule Documentation Requirements and Payment for Evaluation and Management Visits and Advancing Virtual Care (PDF) Physician Fee Schedule (PFS) Payment for Office/Outpatient Evaluation and Management (E/M) Visits - Fact Sheet (PDF) - Updated 01/14/2021.

  13. Understanding the landmark E/M Office Visit changes

    Contents. On Jan. 1, 2021, the Evaluation and Management (E/M) Office Visit code changes went into effect. Incorporating these groundbreaking revisions into physician workflows, software, health plans and elsewhere is vital to realizing the benefits of this burden reduction initiative. The AMA and Nordic have collaborated to author three white ...

  14. Evaluation and Management (E/M) Code Changes 2021

    RVUs for 2021 Office/Outpatient E/M Codes. E/M visits comprise approximately 40% of allowed charges for MPFS services, and office/outpatient E/M visits comprise approximately 20% of allowed charges, the MPFS 2021 final rule states. As a result, pricing of these codes is an important subject, both for providers and for Medicare.

  15. Evaluation & Management (E/M) Codes Cheat Sheet

    Risk of complications. To determine the appropriate E&M visit, two out of three elements must match the same level. Level-II visit involves straightforward MDM and Level-III visit contain low-complexity MDM with a problem-focused exam of the affected body area plus one symptomatic related area. The applicable code for a level-II visit is 99212 ...

  16. Mastering E&M Codes: Guide to Evaluation & Management Coding

    Evaluation and management codes, often referred to as E&M codes or E and M codes are a coding system that involve the use of CPT codes from the range 99202 to 99499 which represent services provided by a physician or other qualified healthcare professional. These evaluation and management CPT codes are utilized when the provider is involved in either evaluating or managing patient health.

  17. The 2023 Hospital and Nursing Home E/M Visit Coding Changes

    Initial nursing home visits are coded with 99304-99306. CPT is deleting the code for nursing home annual exams (99318), which will instead be coded as subsequent nursing home visits (99307-99310 ...

  18. Coding for E/M home visits changed this year. Here's what you ...

    Select these codes based on either your level of medical decision making or total time on the date of the encounter, similar to selecting codes for office visits. The E/M codes specific to ...

  19. Decoding Coding: Tips and Resources for the Young Ophthalmologist

    E/M vs. Eye Codes. Ophthalmologists have two options for outpatient visits — eye visit or evaluation and management (E/M) codes. Eye Visit Codes (920XX) These codes include both new (9200X) and established (9201X) patients with two types of visits to choose from — comprehensive and intermediate.

  20. 10 FAQs About E/M Guidelines and Coding

    Industry experts explain the intricacies of the 2021 E/M guidelines. During the Evaluation and Management Panel general session at AAPC's HEALTHCON in March, an expert panel made up of a physician, coder, auditor, payer, and a representative from the American Medical Association (AMA) answered audience questions regarding the 2021 E/M guidelines for office/outpatient visits.

  21. 2025 JustCoding Pocket Guide

    The E/M Office Visit Reference Guide, Third Edition, delivers a comprehensive overview of the E/M documentation guidelines and a clear, in-depth analysis of all updates and changes, including guidance on the medical decision-making (MDM) guidelines so that you can ensure accurate coding and billing.

  22. Trends in Billing Secure Messages as E-Visits

    We measured e-visit claims, in total, by CPT code, and as a proportion of all evaluation and management (E&M) visits monthly, as well as the number and proportion of unique organizations (determined by type 2 National Provider Identifier ... E-visits for CPT code 99423 were most commonly associated with diagnoses for hypertension (18.0%).

  23. E/M Coding History, Exam and MDM Components

    Evaluation and management (E/M) codes are found in the CPT ® code set in the range 99202-99499 and cover a variety of services. Many E/M codes, such as those for inpatient care and home visits, include a combination of patient history, examination, and medical decision making (MDM). These factors — history, exam, and MDM (HEM) — are known ...

  24. Evaluation and Management (E/M) Code Changes 2023

    The E/M codes for home care services now include any patient residence, including assisted living facilities, which prior to 2023 had a separate code category (99324-99328, 99334-99337). Now all home or residence services are reported using codes 99341-99345 for new patients and 99347-99350 for established patients.

  25. E/M office visit coding series: Tips for time-based coding

    The 2021 E/M office visit coding changes allow physicians to code visits based solely on total time, which is defined as the entire time you spent caring for the patient on the date of the visit.

  26. Teachable Machine

    Train a computer to recognize your own images, sounds, & poses. A fast, easy way to create machine learning models for your sites, apps, and more - no expertise or coding required.

  27. E/M Calculator

    Date of Service *. Type of Service *. Use the E/M Calculator from the experts at Codify. Check CMS Documentation Guidelines, Time-Based Coding, and get on the fast track to E/M level accuracy.

  28. Calculate Provider Minutes When Performing Phone Visits

    Can the provider bill for time spent with the patient? California Subscriber. Answer: Unfortunately, the maximum time you can bill for a telephone evaluation and management (E/M) visit is 30 minutes.Therefore, you'll assign 99443 (Telephone evaluation and management service by a physician or other qualified health care professional who may report evaluation and management services provided ...