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A Quick Guide to E&M Codes in Medical Billing

In medical billing evaluation and management, or E&M, codes are among those most frequently used. However, because of the many nuances that go into evaluation and management services, understanding E&M codes can be surprisingly complex, even to those with plenty of experience when it comes to medical coding. Breaking down some of these complexities can make the task of working with these codes a little simpler the next time you need to process them in a patient’s records.

Code Components

E&M codes have many components, all of which have to do with how a patient is evaluated and the types of services that is provided in the evaluation and management process. The components of these codes include:

  • Chief Complaint
  • History of Present Illness
  • Review of Symptoms
  • Past, Family and Social History
  • Examination
  • Medical Decision Making

Within each point, there are many more smaller details that can change the way evaluation and management is coded. For example, medical decision making can vary from straightforward to high complexity in categorization.

Flexibility

E&M codes are flexible in design because this adaptability makes them suitable for use in a wide variety of situations. However, this flexibility can add to the complexity of understanding these codes. It’s important to note though there are gray areas when it comes to these kinds of codes, they must still fit into certain categories. Some examples of categories include emergency department services, hospital inpatient services and nursing facility services.

While complex, it’s important to know how to properly use E&M codes when working with medical billing. The use of an E&M calculator can be beneficial, even to those who are already skilled with medical billing work, because it can help cut through some of the ambiguity and give you an idea of the codes you need for the coding process.

You can access a calculator for E&M codes online at GeBBS Healthcare Services. If you would like to learn more about what they can do, they can also be contacted by phone at 888-539-4282.