Evaluation and Management codes are insurance billing codes for evaluating a patient's condition. They cover both new patient and returning patient visits.
As an acupuncturist, knowledge of these codes enable you to properly bill your patients, and provide a higher level of patient care.
The information presented is meant to be an introduction and is by no means comprehensive.
New Patient vs Returning Patient
The E/M codes are split into new patient and returning patient codes. The new patient codes are 99201 to 99205. And, the returning patient codes are from 99211 to 99215.
A new patient is someone who, within the last 3 years, has not received any professional services from the physician or another physician of the same specialty within the same practice. (In other words, once every 3 years.)
A returning patient is someone who, within the last 3 years, has received professional services from the physician or another physician of the same specialty within the same practice. (Typically, every 4 weeks.)
Patient History, Examination, & Medical decision-making
Three criteria determine the appropriate billing for an E/M visit. They are Patient History, Examination, and Medical decision-making. And, each of these, is broken down into subcategories.
For acupuncture, 99203 is the most common new patient E/M billing code and 99213 is the most common for returning patient.
An acupuncture service already contains a pre & post evaluation as part of the visit and codes. So, if an E/M service is done, in addition, to the acupuncture service, then the modifier -25 is added to the billing code.
Document, Document, Document
In general, good documentation is good patient care. In additional, proper documentation is key in supporting your billing decisions.
If you would like to learn more, I found the AAC Network's Essential Billing and Coding Seminar to be educational.
In additional, the following 2 articles were helpful.
Questions? Let me know in the comments below. I'd love to hear from you.
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