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Evaluation and management (E/M) services
What are evaluation and management (E/M) services? E/M services refer to diagnostic or therapeutic procedures furnished by physicians or non-physician practitioners (i.e., nurse practitioners, clinical nurse specialists, certified nurse midwives, and physician assistants). E/M services are the most common services billed by Medicare physicians.
How are E/M codes selected for the service performed? Billing Medicare for a patient visit requires the selection of the code that best represents the level of E/M service that was performed and effectively documented in the patient’s medical record. The E/M code selected must be supported by the medical documentation, which should indicate levels pertaining to the history, examination, and/or medical decision-making of the corresponding patient encounter.
Why are E/M services a focus for Medicare? Audit results from Medicare claim review programs (e.g., Comprehensive Error Rate Testing [CERT]) indicate that E/M services are often coded incorrectly, with providers either “upcoding” or “downcoding,” resulting in an increase to the percentage of improper payments made by the Medicare program.
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