Coding Guidelines for E&M Services

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Coding Guidelines for EM Services

• CPT codes for Evaluation Management (EM)
  services are principally included in the CPT code
  range 99202-99499. The codes describe the site of
  service (e.g., office, hospital, home, nursing
  facility, emergency department, critical care),
  the type of service (e.g., new or initial
  encounter, follow-up or subsequent encounter),
  and various miscellaneous services (e.g.,
  prolonged physician service, care plan oversight
  service). Some EM codes are based on the
  duration of the encounter (e.g., per diem
  services.) If a physician performs a consultation
  EM, the provider may report the appropriate
  level of EM service for the site of service
  where the consultation EM occurs. Coding
  guidelines for EM services are as follows
• Coding Guidelines for EM Services
• Rules governing the reporting of more than one
  EM code for a patient on the same date of
  service are very complex and are not mentioned in
  this article.
• A provider may report only one new patient code
  on a single date of service.
• A provider may report only one code from a range
  of codes describing an initial EM service on a
  single date of service.
• A provider may report only one per diem EM
  service from a range of per diem codes on a
  single date of service.

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Coding Guidelines for EM Services

• A provider shall not report an initial per diem
  EM service with the same type of subsequent
  per diem service on the same date of service.
• A provider shall not double count time if
  reporting more than one EM service for the same
  date of service or same monthly period.
• EM codes describing observation/inpatient care
  services with admission and discharge on same
  date (CPT codes 99234-99236) shall not be
  reported on the same date of service as initial
  hospital care per diem codes (99221-99223),
  subsequent hospital care per diem codes
  (99231-99233), or hospital discharge day
  management codes (99238-99239).
• The prolonged service with direct face-to-face
  patient contact EM codes (CPT codes 99354-
  99357) may be reported in conjunction with some
  EM codes.
• Since critical care (CPT codes 99291-99292) and
  prolonged EM services (CPT codes 99354- 99357)
  are reported based on time, providers/suppliers
  shall not include the time devoted to performing
  separately reportable services when determining
  the amount of critical care or prolonged provider
  EM service time.
• EM services, in general, are cognitive services,
  and significant procedural services are not
  included in EM services. Certain procedural
  services that arise directly from the EM service
  are included as part of the EM service. For
  example, cleansing of traumatic lesions, closure
  of lacerations with adhesive strips,

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Coding Guidelines for EM Services

• application of dressings, counseling
  and educational services are included in EM
  services.
• Because of the intensive nature of caring for
  critically ill patients, certain practitioner
  services in addition to patient history,
  examination, and medical decision making are
  included in the evaluation and management
  associated with critical and intensive care.
• Services not separately reportable by
  practitioners reporting critical care CPT codes
  99291 and 99292 include, but are not limited to,
  the interpretation of cardiac output measurements
  (CPT codes 93561 and 93562), chest X-rays (CPT
  codes 71045 and 71046), blood gases, and data
  stored in computers (ECGs, blood pressures,
  hematologic data), gastric intubation (CPT codes
  43752, 43753), temporary transcutaneous
  monitoring (CPT code 92953), ventilator
  management (CPT codes 94002-94004, 94660, 94662),
  and vascular access procedures (CPT codes 36000,
  36410, 36600). However, facilities may separately
  report these services with critical care CPT
  codes 99291 and 99292.
• Practitioner inpatient neonatal and pediatric
  critical and intensive care services (i.e., CPT
  codes 99468-99480) include the same services
  included in critical care CPT codes 99291 and
  99292. These services shall not be reported
  separately by practitioners reporting CPT codes
  99468-99480. However, facilities may separately
  report these services with CPT codes 99468-99480.

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Coding Guidelines for EM Services

• If a procedure has a global period of 090 days,
  it is defined as a major surgical procedure. If
  an EM service is performed on the same date of
  service as a major surgical procedure for the
  purpose of deciding whether to perform this
  surgical procedure, the EM service is separately
  reportable with the appropriate modifier. Other
  preoperative EM services on the same date of
  service as a major surgical procedure are
  included in the global payment for the procedure
  and are not separately reportable.
• If a procedure has a global period of 000 or 010
  days, it is defined as a minor surgical
  procedure. In general, EM services on the same
  date of service as the minor surgical procedure
  are included in the payment for the procedure.
  The decision to perform a minor surgical
  procedure is included in the payment for the
  minor surgical procedure and shall not be
  reported separately as an EM service. However, a
  significant and separately identifiable EM
  service unrelated to the decision to perform the
  minor surgical procedure is separately reportable
  with modifier 25. The EM service and minor
  surgical procedures do not require different
  diagnoses. If a minor surgical procedure is
  performed on a new patient, the same rules for
  reporting EM services apply. The fact that the
  patient is new to the provider is not
  sufficient alone to justify reporting an EM
  service on the same date of service as a minor
  surgical procedure.
• For major and minor surgical procedures,
  postoperative EM services related to recovery
  from the surgical procedure during the
  postoperative period are included in the global
  surgical package as are EM

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Coding Guidelines for EM Services

• services related to complications of the surgery.
  Postoperative visits unrelated to the diagnosis
  for which the surgical procedure was performed
  unless related to a complication of surgery may
  be reported separately on the same day as a
  surgical procedure with modifier 24 (Unrelated
  Evaluation and Management Service by the Same
  Physician or Other Qualified Health Care
  Professional During a Postoperative Period).
• CPT codes 99238 and 99239 describe hospital
  discharge day management. These codes shall not
  be reported with initial hospital care (CPT codes
  99221-99223) or initial observation care (CPT
  codes 99218-99220) for the same date of service.
  If a physician provides initial hospital care or
  observation care on the same day as discharge,
  the services shall be reported with CPT codes
  99234-99236 (Observation or inpatient hospital
  care with admission and discharge on the same
  date of service). Additionally, CPT codes 99238
  and 99239 include all physician services provided
  to the patient on the date of discharge. The
  provider shall not report another EM CPT code
  (e.g., 99202-99215, 99281-99285) on the same date
  of service that the provider reports CPT code
  99238 or 99239.
• CPT Copyright 2022 American Medical Association
• Medical Billers and Coders (MBC) is a leading
  medical billing company providing
  complete revenue cycle

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Coding Guidelines for EM Services
management services. We shared coding guidelines
for EM services so that providers will get
accurately reimbursed for delivered services. We
referred various source materials along with the
Medicare coding manual to discuss medical billing
for cardioversion in detail. If you need any
assistance in medical billing and coding for your
practice, email us at info_at_medicalbillersandcoder
s.com or call us at 888-357-3226.