Evaluation and management coding (commonly known as E/M coding or E&M coding) is a
medical coding
A clinical coder—also known as clinical coding officer, diagnostic coder, medical coder, or nosologist—is a health information professional whose main duties are to analyse clinical statements and assign standard codes using a classification ...
process in support of
medical billing
Medical billing is a payment practice within the United States healthcare system. The process involves a healthcare provider obtaining insurance information from a patient and filing, following up on and appealing claims with health insurance co ...
. Practicing health care providers in the United States must use E/M coding to be reimbursed by
Medicare,
Medicaid
Medicaid in the United States is a federal and state program that helps with healthcare costs for some people with limited income and resources. Medicaid also offers benefits not normally covered by Medicare, including nursing home care and pers ...
programs, or
private insurance
Insurance is a means of protection from financial loss in which, in exchange for a fee, a party agrees to compensate another party in the event of a certain loss, damage, or injury. It is a form of risk management, primarily used to hedge ...
for patient encounters.
E/M standards and guidelines were established by Congress in 1995 and revised in 1997. It has been adopted by private
health insurance
Health insurance or medical insurance (also known as medical aid in South Africa) is a type of insurance that covers the whole or a part of the risk of a person incurring medical expenses. As with other types of insurance, risk is shared among ma ...
companies as the standard guidelines for determining type and severity of patient conditions. This allows medical service providers to document and bill for reimbursement for services provided.
E/M codes are based on the
Current Procedural Terminology
The Current Procedural Terminology (CPT) code set is a procedural code set developed by the American Medical Association (AMA). It is maintained by the CPT Editorial Panel. The CPT code set describes medical, surgical, and diagnostic services and ...
(CPT) codes established by the
American Medical Association
The American Medical Association (AMA) is a professional association and lobbying group of physicians and medical students. Founded in 1847, it is headquartered in Chicago, Illinois. Membership was approximately 240,000 in 2016.
The AMA's state ...
(AMA).
In 2010, new codes were added to the E/M Coding set, for prolonged services without direct face-to-face contact.
See also
*
Resource-based relative value scale Resource-based relative value scale (RBRVS) is a schema used to determine how much money medical providers should be paid. It is partially used by Medicare in the United States and by nearly all health maintenance organizations (HMOs).
RBRVS assig ...
References
External links
E/M Calculator 2021Department of Health and Human Services,Centers for Medicare & Medicaid Services: Evaluation and Management Services GuideMedScape:Correct Coding Helps You Get Paid What You're WorthEvaluation of EHR Coding ToolsE/M Utilization Benchmarking Tool
Medicare and Medicaid (United States)
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