Evaluation / Management

CODE.MODE

E/M

Evaluation & Management Codes

E/M Codes are one of the six sections of the CPT Category I codes and range from 99201-99499.

Guidelines

Classification

Separate Procedures

Codes designated as "separate procedure" are NOT reported in addition to the code for the total procedure or service of which it is considered an integral component.

Codes designated as "separate procedure" MAY be reported by itself or in addition to another procedure / service by adding Modifer -59 to the "separate procedure" code IF they are carried out independently or considered unrelated or distinct. (Examples include a different session or encounter, a different procedure or surgery, different site/organ system, separate incision/excision, separate lesion, separate injury, or area of injury in extensive injuries.)

Separate Procedures

Codes designated as "separate procedure" are NOT reported in addition to the code for the total procedure or service of which it is considered an integral component.

Unlisted Procedure / Service

Unlisted codes are reported for services that are not included in the CPT book. If reporting such a service, the appropriate "Unlisted Procedure" code may be used to indicate the service, identifying it as a "Special Report."

Special Report

Some services that are new, rarely provided, variable, or unusual require a special report. These reports must include pertinent information, including a description of the following:

nature, extent, & need for procedure
time, effort, & equipment necessary

Imaging Guidance

Guidelines for image documentation for Radiology (Including nuclear Medicine and Diagnostic Ultrasound) will apply when imaging or imaging supervision and interpretation is included in a procedure.

Supplied Materials

Supplies and materials exceeding those usually included may be listed separately.

RANGE

99201-99499

SUBSECTIONS

Office or Other Outpatient Services
Hospital Observation Services
Hospital Inpatient Services
Consultations
Emergency Department Services
Critical Care Services
Nursing Facility Services
Domiciliary, Rest Home (Boarding Home), or Custodial Care Services
Domiciliary, Rest Home (Assisted Living Facility), or Home Care Plan Oversight Services
Home Services
Prolonged Services
Case management Services
Care Plan Oversight Services
Preventative Medicine Services
Non-Face-To-Face Services
Special Evaluation and Management Service
Newborn Care Services
Delivery/Birthing Room Attendance & resuscitation Services
Inpatient Neonatal Intensive Care Services & Pediatric & Neonatal Critical Care Services
Care Management Services
Transitional Care Management Services
Advance Care Planning
Other Evaluation & Management Services

MODIFIERS

CPT Category I Modifiers
Anesthesia Modifiers

HELPFUL LINKS

Coding

www.ama-assn.org/go/cpt

Medical Terms

https://quizlet.com/24630342/pharmaceutical-terms-abbreviations-and-meanings-flash-cards/

BACK TO CPT OVERVIEW

Add-on Codes +

An add-on code is an additional or supplementary procedure in addition to the primary procedure being performed. These are designated with the + symbol and are listed in Appendix D. Tip: Look for "each additional" or "(List separately to primary procedure."

ALWAYS reported with primary
NEVER a stand-alone Code
NEVER reported with Modifier -51