What are Evaluation and Management Medical Billing Codes - dummies

What are Evaluation and Management Medical Billing Codes

Evaluation and management (E&M) codes are the most commonly billed codes and the medical coder/biller will use them a lot. These are the codes for every office visit and encounter a physician has with a patient, which typically involve non-invasive physician services.

When you use these codes, you find that your knowledge of medical terminology and medical necessity really comes into play because everything has a code! Here’s a general list of the kinds of things that have their own E&M codes:

  • Office visits by new patients

  • Office visits by established patients

  • Emergency room visits

  • Observation visits (when the patient is in the hospital but not admitted because he’s just being observed)

  • Consultation visits (visits that have been requested by another physician, provider, or healthcare entity.)

Other codes include codes specific to hospitalized patients, codes for treating patients in nursing homes, critical care codes, and codes for assisted living/rest home visits.

The E&M visit may take place in a physician’s office, nursing home, patient’s home, hospital, emergency room, or clinic.

If the examination takes place during an office visit or a hospital visit, or if the patient has been referred for a specialized evaluation, the visit may technically be referred to as a consultation, which simply means that it’s been requested by another physician or healthcare provider. Before you can bill a consultation, specific requirements must be met.