Evaluation and Management (E/M) CPT Codes

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.

Modifier -25

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.

Example: 99203-25

Document, Document, Document

In general, good documentation is good patient care. In additional, proper documentation is key in supporting your billing decisions.

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