Evaluation and Management
EVALUATION AND MANAGEMENT
E/M coding is the process that physicians, use to translate the patients visit into a five
digit CPT( current procedural terminology) codes, so they can submit it to the insurance
company for payment. Every procedure has it own CPT codes that describe the different level of care at the time of the physician-patient encounter. Every patient encounter is a unique procedure that requires specific documentation. Each individual E/M code has a set of rules called E/M guidelines. The Center for Medicare and Medicaid Services developed these guidelines (CMS) and the American Medical Association. They released the first version in 1995 and they released the latest version in 1997. Each version has its advantages and disadvantages, and mixing and matching the two sets of rules within the same medical documentation is not acceptable. Understanding the difference between the two guidelines and their unique set of rules that apply to them is very important. Medical records are used to document facts, findings and observations about an individual health history, both past and present illnesses, examinations, tests, treatments, and outcome. The medical record documents the care of the patient and is important to the quality of care the patient receives. The medical records make it easier:
▸ For the physician and other health care professionals to evaluate and plan the patient’s treatment, and to monitor their health overtime
▸ Provide communication and constant care between physicians and other health care professionals that participate in the care of the patients
▸ Make accurate and timely claims and reviews and payment
▸ For reviews and quality of care evaluations
▸ For collection of information that can be of use for research and education
Because insurance companies have an obligation to their enrollees, they require documentation of services that are consistent with the coverage that they provide; the site of
E/M coding is the process that physicians, use to translate the patients visit into a five
digit CPT( current procedural terminology) codes, so they can submit it to the insurance
company for payment. Every procedure has it own CPT codes that describe the different level of care at the time of the physician-patient encounter. Every patient encounter is a unique procedure that requires specific documentation. Each individual E/M code has a set of rules called E/M guidelines. The Center for Medicare and Medicaid Services developed these guidelines (CMS) and the American Medical Association. They released the first version in 1995 and they released the latest version in 1997. Each version has its advantages and disadvantages, and mixing and matching the two sets of rules within the same medical documentation is not acceptable. Understanding the difference between the two guidelines and their unique set of rules that apply to them is very important. Medical records are used to document facts, findings and observations about an individual health history, both past and present illnesses, examinations, tests, treatments, and outcome. The medical record documents the care of the patient and is important to the quality of care the patient receives. The medical records make it easier:
▸ For the physician and other health care professionals to evaluate and plan the patient’s treatment, and to monitor their health overtime
▸ Provide communication and constant care between physicians and other health care professionals that participate in the care of the patients
▸ Make accurate and timely claims and reviews and payment
▸ For reviews and quality of care evaluations
▸ For collection of information that can be of use for research and education
Because insurance companies have an obligation to their enrollees, they require documentation of services that are consistent with the coverage that they provide; the site of
Cited: CPT 2008 Standard Edition. Chicago, Illinois: American Medical Association, 2007. "Free E/M coding tools." E/M Coding Education, EM evaluation and management coding, e&m documentation, 99214, 99213. Ed. Peter R. Jensen MD, CPC. 11-21 Feb. 2009 . American Medical Association. 11-21 Feb. 2009 . "UB Medical Compliance." Untitled Document. 21 Feb. 2009 .