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Evaluation And Management

Evaluation And Management

Correct coding and billing for evaluation and management (E&M) stymies many practices. Medicare payers have identified these E&M codes, especially, as problematic: New patient office or other outpatient visits — CPT codes 99201-99205. Established patient office or other outpatient visits — CPT codes 99211-99215.
Evaluation and management coding (commonly known as E/M coding or E&M coding) is a medical coding process in support of medical billing. This allows medical service providers to document and bill for reimbursement for services provided.
Evaluation and management coding is a medical coding process in support of medical billing. Practicing health care providers in the United States must use E/M coding to be reimbursed by Medicare, Medicaid programs, or private insurance for patient encounters.
E/M codes are based on the Current Procedural Terminology (CPT) codes established by the American Medical Association (AMA). In 2010, new codes were added to the E/M Coding set, for prolonged services without direct face-to-face contact.

  • Becoming a CPC demonstrates you have:
  • Expertise in medical record review to abstract information required to support accurate inpatient coding
  • Expertise in assigning accurate ICD-10 medical codes for diagnoses and procedures performed in the inpatient setting
  • Superior knowledge of current rules, regulations, and issues regarding medical coding, compliance, and reimbursement under MS-DRG system and IPPS
  • Strong ability to integrate coding and reimbursement rule changes in a timely manner to include updating the charge description master (CDM), fee updates, and the Field Locators (FL) on the UB04
  • Solid understanding of anatomy, physiology, and medical terminology required to correctly code facility services and diagnoses
  • Understanding of Hospital Outpatient Prospective Payment System (OPPS) reimbursement methodologies