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HCFA E/M Code Guidelines

The Health Care Financing Administration, or HCFA, was created to administer Medicare and Medicaid programs. Evaluation and management, or E/M, coding refers to the process by which physician-patient interactions are translated to facilitate billing.

  1. History

    • E/M numeric codes represent medical services rendered and are submitted to insurers for payment. Documentation requirements for individual E/M codes are clarified in a set of rules called E/M guidelines. The guidelines were first created in 1994 by the Center for Medicare and Medicaid Services and the American Medical Association, or AMA. A revised version, the creation of which included collaboration with HCFA, was released in 1997.

    Guidelines

    • HCFA and AMA developed numerous changes, implementing terminology and resulting E/M codes related to patient history, examination levels and definitions as well as simplification of specific body areas and organ systems. Additional code guidelines include defining physiological tests, medication risk management and surgical procedures.

    Significance

    • Doctors, professional medical organizations and insurance companies widely complained about the complexity of the original guidelines, leading to a great deal of debate about their practical implementation. E/M code revisions were eventually settled upon and put into long-term practice.

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