E&M Coding

Medical record documentation plays a vital role in the healthcare system. Recording relevant facts, findings, and observations regarding a patient’s unique health history allows medical facilities to properly bill for services rendered. All too often, however, physicians undercode for these services, leaving would-be revenue on the table.

With decades of experience, high-level expertise, more than 2,000 employees, and over 31 million claims processed each year, Coronis Health understands how to improve E&M coding processes to maximize reimbursement for our clients. 

What Is E&M Coding?

Evaluation and management (E&M) codes cover three important areas: medical history, examination, and decision making. Often referred to as “patient-physician encounter” codes, many types of E&M codes exist. Each type of encounter, such as a primary care or hospital visit, fits under a different level of care in E&M coding.

For example, the code 99214 charges for an office visit with an established patient. This type of encounter alone includes five different levels of care. The 99214 code describes a “level 4” office visit because the code ends in the number “4.” It is also the fourth “level of care” for that type of visit (99215 is the fifth and highest level of care). Each patient care encounter may be viewed as a unique procedure, requiring specific documentation.

What Is Covered Under E&M Coding?

E&M codes cover a broad range of services provided by primary care physicians, emergency room physicians, and specialty care physicians. A variety of home health, consultative, nursing, preventive, and hospital visit services require accurate E&M codes for accurate billing.

Common services in which E&M codes are applicable include:

• Counseling
• Medical history
• Coordination of care
• Nature of problem presented
• Time spent with patients
• Patient and caregiver education
• Documentation of clinical information
• Ordering medications, tests, or other procedures
• Referrals to other healthcare providers
• Reviewing test results

E&M Coding Challenges

Physicians consistently undercode for E&M services, often because the rules surrounding these codes are too complex to follow while managing a medical facility and providing patient care. 

Common challenges in E&M coding include:

• Shift to EHRs
  
  • Providers often rely on electronic health records (EHRs) to gather patient data and ensure proper coding. Unfortunately, EHRs can’t always identify the proper codes for complex services, such as medical decision-making, which often results in improper coding.

• Multiple Criteria
  
  • From chart documentation and physician notes to recording the nature of a medical concern, E&M coding isn’t as black and white as traditional medical coding.
    
• Overcoding
  
  • While physicians notoriously undercode for services, overcoding for E&M is on the rise — and so are automatic claim denials. This phenomenon is particularly true for emergency room physicians, who often work in a gray area when it comes to coding.

How Coronis Health Can Help

With Coronis Health as your partner, you have an ally who understands the nuances of E&M coding. Our medical billing and revenue cycle management team works with thousands of medical facilities, independent physicians, and all types of specialties to ensure your coding practices are accurate and compliant.

What Coronis Offers

• E&M Documentation Education
  
  • Applying the right E&M codes starts with accurate documentation. “If it isn’t documented, it hasn’t been done” is an adage frequently heard in the healthcare sector. Our team works directly with physicians and their care teams to implement proper documentation practices from the moment a patient schedules a visit.
    
• Automated Coding Services
  
  • Coronis Health uses proprietary technology to automate the E&M coding process as quickly and efficiently as possible.

• Claim Denial Follow-Up
  
  • Our team collects every last dollar, even if your initial claim is denied, whether we need to submit a corrected claim or file a full appeal.

Coronis Health knows that accurately billing for services rendered from the start is the best way to ensure you receive payment for services rendered. Allow our team to take on your administrative burden so you can focus your attention, time, and resources on the patients who need it most.

Schedule a free financial health assessment today to find missing revenue in your RCM. 

Contact Coronis Health today to learn more. We find missing revenue in 95% of our financial health check-ups and are confident that we can maximize yours.