Evaluation And Management Coding

Categories: Healthcare IT
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About Course

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.

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What Will You Learn?

  •  Pragmatic learning approach
  •  Assessments/polls and feedback (very critical)
  •  Chart dissection process (learn from scratch)
  •  Chart coding and code capturing skills
  •  Case presentation activities (builds confidence)
  •  Acquire ‘Defend your code’ skills (audit purpose)
  •  Interview preps

Course Content

E&M coding and its significance

Physician coding concepts

Outpatient office visits

Observation visits

Inpatient E/M coding

95/97 vs 2021 E/M coding guidelines

Contributory factors of E/M

Prolonged services (2021)


Preventive services coding

Medicare AWV and WTM guidelines

NICU visits

Incident to services

Split/shared and resident service coding


Modifiers with global period concepts

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