East Bay Nephrology Medical Group
E&M Education
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Introduction
and Definitions This tutorial is to provide physicians with the tools they need to educate themselves about E/M coding and documentation. E/M stands for “evaluation and management”. E/M coding is the process by which physician-patient encounters are translated into five digit CPT codes to facilitate billing. CPT stands for “current procedural terminology.” These are the numeric codes which are submitted to insurers for payment. Every billable procedure has its own individual CPT code. The fundamental principle is that knowledge is power when it comes to E/M coding and documentation. Too many physicians are chronically under-coding for their services because they don’t understand the rules. A working knowledge of the E/M coding is the best way to ensure optimal compliance and avoid inadvertent under-coding. Physicians who are simplistic with the peculiar process of E/M documentation can command a higher rate of return on their cognitive labor than their less E/M-savvy counterparts. In other words if you know how to accurately bill for your services, there is a better chance you will get paid for what you really do. The CPT codes which describe physician-patient encounters are
often referred to as “E/M codes”
There are different E/M codes for different types of encounters such as
office visits or hospital visits. Within each type of encounter,
there are different levels of care. For example, the 99214 code may
be used to charge for an office visit with an established patient.
There are five levels of care for this type of encounter. The 99214
code is often called a “level 4” office visit because the code ends in
a “4” and also because it is the fourth “level of care” for that
type of visit (with the 99215 being the fifth and highest level of care).
Each patient care encounter may be viewed as a unique procedure which
requires specific documentation. The
Key Components of E/M Documentation The
documentation for E/M services is based on three
“key” components:
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