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Become a member and receive career-enhancing benefits

Our top priority is providing value to members. Your Member Services team is here to ensure you maximize your ACS member benefits, participate in College activities, and engage with your ACS colleagues. It's all here.

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ACS
Practice Management

Guidelines for E/M Reporting

Documentation requirements for E/M visits will also be revised to include two separate sets of reporting guidelines:

  • One set for reporting office/outpatient E/M visits
  • One set for reporting all other E/M visits that are not furnished in the office/outpatient setting

The table below highlights several major differences in reporting guidelines for E/M visits that went into effect on January 1, 2021

Question

Office/Outpatient E/M Visits (99202-99205, 99211-99215, 99417, G2212)

All Other E/M Visits (e.g., consultation, inpatient, observation, nursing home, emergency department visits)

Which reporting guidelines apply to E/M services?

New: Code selection is based on medical decision making OR total time on the date of encounter.

No change: The 1995 and 1997 E/M documentation guidelines continue to apply to all other E/M services not furnished in the office or other outpatient setting.

Are history and physical examination (H&P) required elements? 

New: History and/or examination is required only as medically appropriate for all levels of both new and established patient codes.

No change: The four categories of H&P (problem focused, expanded problem focused, detailed, and comprehensive) are still applicable in E/M code selection. 

When using time for reporting, how should it be used for code selection?

New: Code selection is based on total face-to-face and non-face-to-face time of the billing provider on the date of the encounter.

No change: Time may only be used for code selection when counseling and/or coordination of care dominates the service.