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.