What is an Evaluation and Management (E&M) Visit in Medical Billing?

When working with medical billing for insurance companies there can be a lot of confusion about the Medical Billing Terminology used.

One term that is commonly used is E&M visit, which is short form for Evaluation and Management Encounter.

This is essentially referring to a doctor’s visit, or a consultation (a visit requested by another physician or healthcare entity).

During a patient visit (sometimes known as an encounter) a physician examines the patient, documents his or her findings, and then determines the best course of action for treatment.

The Current Procedural Terminology (CPT) codes cover evaluation and management ( E&M) services, which clinicians use in billing for office and hospital visits. E&M visits are easily recognizable medical services such as a visit to urgent care, hospital admission, or daily rounds on people admitted to a hospital.

It is important to remember that insurance companies only pay for procedures that are medically necessary to the well-being of the patient. For that reason you must link each procedure billed to a medical diagnosis that supports the medical necessity for the procedure.

Whether a physician conducts an E&M visit or a consultation, he or she will report some sort of illness or disease-related term in the patient’s record, even if the problem is something as simple as the common cold.

Then you must ensure you are using the correct codes. It is important to understand the verbiage used in the record, as well as surgical procedures, evaluation and management procedures.