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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 

Co

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. 

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.) 

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 

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

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