E&M coding stands for Evaluation and Management coding. E&M Coding uses the CPT codes from 992020 until 99499 to denote specific services delivered by physicians and other qualified healthcare professionals. E&M coding covers hospital visits, preventive medicines resources, and home services. It can also include office visits. As long as it is a service or a visit that evaluates and helps manage patient health, it falls under E&M.
Inpatient E&M coding in standard hospital care
During a patient’s stay and consultation with a health care provider, from receiving initial care up to discharge, there are involved E&M Codes that track and report the patient’s activity and the services they receive.
Initial hospital care
When the patient first interacts with an admitting physician, they are interviewed and documented to determine their history, examination, and previous medical decisions. These are all important of the documentation for claims later on.
All the E&M services provided during this state must be related to the admission and reported together with the admission documentation to identify the necessary initial hospital care.
The codes involved in this stage are 99221, 99222, and 99223.
Subsequent inpatient care
After initial care, changes in the patient, and any diagnostic results that need review, are recorded. This stage has the E&M codes 99231, 99232, and 99233.
Admission and discharge same day
If the patient is admitted as an inpatient and discharged on the same day, different codes are applied depending on the number of hours the patient stays in the facility. If the patient receives medical care and is admitted for less than 8 hours, the codes to use are 99221 to 99223. If the patient remains admitted and receives medical care for at least 8 hours but not more than 24 hours, the codes to use are 99234 to 99236.
Discharge day management services
Inpatient care can go beyond one day. If the patient is discharged on a different calendar date from when they were admitted, they use a different set of CPT codes. The patient needs to be evaluated by a physician or a certified personal face-to-face. The evaluation can happen on a different day.
Only an attending physician can use the Hospital Discharge Day Management Services from CPT 99238 to 99239. Otherwise, codes 99231 to 99233.
Add-on psychiatric care codes
When receiving treatment, the patients may need additional care to meet their health care needs adequately. One specific set of add-on CPT codes involve psychiatric support and services delivered over some time. These codes are 90833, 90836, and 90838.
Let us take a look at 90833. 90833 CPT code is described as an add-on coded for individual psychotherapy, insight-oriented, behaviour modifying and/or supportive, 30 minutes with the patient and/or family member when performed with an evaluation and management service.
Alpha II can help you understand this code more. Look up the FAQs for the 90833 CPT code at alphaii.com.
Final thoughts
It is important to be familiar with these codes to file claims correctly. Always check with your payers to determine the requirements. Alpha II can help you learn more about the codes and better understand billing and E&M coding.
Robert Haynes did his degree in psychology at the University of Edinburgh. He has a particular interest in mental health and well-being.
