E&M Coding Tools

Evaluation and Management (E&M) codes identify a patient encounter with a physician. The E&M code assigned depends on whether the patient is new or established, the place of service where the medical services were rendered and the level of medical decision making involved in the patient's visit. Choosing the proper E&M code can be difficult since so many variables have to be taken into consideration. Several tools are available to help coders to identify the proper E&M code for the patient encounter.

CPT Coding Guidelines

• Refer to the guidelines in the Introduction of the Current Procedural Terminology (CPT) manual. This explains how the CPT manual is organized and important factors to consider when coding from the CPT manual.

CPT Evaluation and Management Guidelines

• Read the guidelines for evaluation and management encounters to help decide which E&M code to use. These guidelines are specific to E&M encounters and explain each aspect of consideration for choosing the proper code.

Professional Organizations

• Contact a professional coding organization such as the American Association of Professional Coders (AAPC) or the American Health Information Management Association (AHIMA). These organizations offer certification and training for medical insurance coders and will be able to assist you with any questions.

Insurance Companies

• Contact the patient's insurance company. Each insurance company has its own coding guidelines. Government insurance entities, such as Medicare and Medicaid, also have their own specific codes.