When working on the Medical Billing in a Doctors office, there is a lot of Medical Billing Jargon and Terminology that you need to understand.

One term that is used a lot is Evaluation and Management (E&M) Coding.

Evaluation and management coding (sometimes abbreviated to E/M coding or E&M coding) is a medical coding process used in medical billing.

All Healthcare providers in the United States must use E&M coding to be reimbursed by Medicare, Medicaid programs, or private insurance for patient encounters.

Evaluation and management (E&M) codes are the most commonly billed codes and most medical coders and billers will use them a lot. These are the codes for every office visit (sometimes known as an encounter) a physician has with a patient.

When you use these codes, you find that your knowledge of medical terminology and medical necessity really comes into play because everything has a code.

As a start, here is a general list of typical E&M codes:

– Office visits by new patients

– Office visits by established patients

– Emergency room visits

– Observation visits (when the patient is in the hospital but not admitted because he’s just being observed)

– Consultation visits (visits that have been requested by another physician, provider, or healthcare entity.)

E&M standards and guidelines were established by Congress in 1995 and revised in 1997. E&M codes are based on the Current Procedural Terminology (CPT) codes established by the American Medical Association (AMA).

These coding practices have 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.

In 2010, new codes were added to the E&M Coding set, for prolonged services without direct face-to-face contact, such as in Telemedicine consultations.