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
Health care or healthcare is the improvement of health via the prevention, diagnosis, treatment, amelioration or cure of disease, illness, injury, and ...
programs, or
private insurance 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 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 stat ...
(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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