Glossary · Coding
Glossary · CodingE/M Coding (Evaluation and Management)
The CPT code family (99202-99499) for office visits, hospital visits, and consultations. Levels (e.g., 99213 vs 99214) are determined by complexity of medical decision-making or total time.
Definition
E/M Coding (Evaluation and Management).
The CPT code family (99202-99499) for office visits, hospital visits, and consultations. Levels (e.g., 99213 vs 99214) are determined by complexity of medical decision-making or total time.
Sources
Primary references for this entry.
- AMA CPT E/M Documentation Guidelines (2021 revision).
- AAPC E/M leveling guide.
Related terms
Other terms in Coding.
- Coding
APC (Ambulatory Payment Classification)
The CMS payment grouping system used for hospital outpatient services under the Outpatient Prospective Payment System (OPPS). APCs bundle services into payment categories with relative weights.
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Bundling
Payer policy that combines multiple billed services into a single payment when one is considered an integral component of another. Often enforced through NCCI edits.
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CPT (Current Procedural Terminology)
The American Medical Association's standardized code set for medical, surgical, and diagnostic procedures. Five-digit numeric codes (with two-digit modifiers) used for professional billing on the CMS-1500 form.
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Downcoding
A payer adjustment that reimburses a billed service at a lower complexity level than coded, typically when documentation is judged insufficient to support the higher level.
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DRG (Diagnosis-Related Group)
The CMS payment grouping system for inpatient hospital services under the Inpatient Prospective Payment System (IPPS). Each DRG carries a relative weight that determines the lump-sum payment.
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HCPCS (Healthcare Common Procedure Coding System)
A CMS-maintained code set divided into Level I (CPT codes) and Level II (alphanumeric codes for products, supplies, and services not in CPT, including durable medical equipment and drugs).
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Frequently asked
About E/M Coding (Evaluation and Management).
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