*99202 – 99499*
• Evaluation and Management coding is a medical
coding process in support of medical billing.
Practicing health care providers in the United States
must use E/M coding to be reimbursed by Medicare,
Medicaid programs, or private insurance for patient
encounters.
E/M standards and guidelines were established by
Congress in 1995 and revised in 1997. It has been
adopted by private health insurance companies as
the standard guidelines for determining type and
severity of patient conditions. This allows medical
service providers to document and bill for
reimbursement for services provided.
Medical decision making (MDM) represents the
provider's cognitive work when seeing a patient and is
the most important of the three components required
to level an E/M service.
Key Elements of Medical Decision Making
The medical decision-making elements associated with codes
99202-99215 will consist of three components:
1) Problem: The number and complexity of problems addressed
2) Data: Amount and/or complexity of data to be reviewed and
analyzed
3) Risk: Risk of complications and or morbidity or mortality of
patient management.
In order to select a level of an E/M service, two of the three
elements of medical decision making must be met or exceeded.
99203