Chapter 11 E/M

2023 evaluation and management service guidelines

• The E/M guidelines have sections that are common to all E/M categories and sections that are category-specific.

• Many categories and subcategories have special guidelines or instructions unique to them.

• Special instructions are presented before the listing of specific E/M service codes (e.g., “Hospital Inpatient and Observation Care”).

• It’s important to review the instructions for each category or subcategory.

• The guidelines help the reporting physician or qualified health care professional select the appropriate level of service.

• The guidelines do not establish documentation requirements or standards of care.

• Documentation supports patient care for current and future health care teams.

• These guidelines apply to services requiring a face-to-face encounter with the patient and/or family/caregiver (clinical staff may perform services for 99211 and 99281).

• The Evaluation and Management section (99202-99499) includes many code categories.

• Each category may have specific guidelines or details.

• The E/M guidelines cover the following categories:

  • Office or Other Outpatient Services

  • Hospital Inpatient and Observation Care Services

  • Consultations

  • Emergency Department Services

  • Nursing Facility Services

  • Home or Residence Services

  • Prolonged Service With or Without Direct Patient Contact on the Date of an Evaluation and Management Service