1
TRAINING DOCUMENT ON E/M MEDICAL
CODING-2026 JUST RELEASED UPDATED
STUDY GUIDE RELEVANT TO ACTUAL
SITTING EXAM
1. What is E/M Coding?
Evaluation and Management (E/M) services are used by physicians and
qualified healthcare professionals (QHPs) to report patient encounters that
involve:
• Evaluating the patient’s health condition.
• Making clinical decisions.
• Managing treatment and follow-up care.
E/M codes describe the cognitive (non-procedural) portion of patient care—
covering the time and medical decision-making involved in the visit.
2. Purpose of E/M Coding in Healthcare
Purpose Description
E/M codes determine the amount providers get paid for
Reimbursement
patient evaluation and decision-making services.
Documentation Ensures consistent recording of patient encounters
Standardization across all specialties and payers.
Supports medical necessity, coding accuracy, and
Compliance
adherence to CMS and payer guidelines.
Used in value-based care models to measure provider
Quality
Measurement performance and patient outcomes.
,2
3. CPT® Code Structure Overview
E/M codes fall under Category I CPT codes (99202–99499), published by the
American Medical Association (AMA).
CPT Section Range Description
For new and established
Office/Outpatient 99202–99215
Services patients seen in an office or
clinic setting.
Used for initial and subsequent
Hospital Inpatient 99221–99239
Services hospital care.
CPT Section Range Description
99242–99245 For consultations requested by
Consultations
(outpatient), another provider.
99252–99255
(inpatient)
Emergency For services provided in an ER,
99281–99285
Department (ED) regardless of new/established
Services status.
For short-term hospital
Observation Services 99218–99236
stays before admission or
discharge.
For life-threatening conditions
Critical Care Services 99291–99292
requiring complex decision-
making.
Nursing Facility & For patients in nursing homes,
99304–99350
Home Services domiciliary, or home settings.
For remote patient encounters
Telehealth/Virtual 99441–99443, 99421–
Care 99423 via phone or video.
,3
□ 4. Key E/M Components (Pre-2023 Guidelines)
Historically, E/M code levels were based on:
1. History (HPI, ROS, PFSH)
2. Examination (extent of physical exam)
3. Medical Decision Making (MDM)
However, 2023+ AMA Guidelines simplified this for Office/Outpatient services
— focusing only on:
• MDM (Medical Decision Making), or
• Total Time Spent on the date of service.
□ 5. Common E/M Visit Types
Visit Type Description Typical Setting
Routine follow-up or new
Office/Outpatient Clinics, physician offices.
Visit patient evaluations.
Hospital Visit Initial or subsequent hospital Inpatient hospitals.
care.
Emergency
Acute care provided in ER Emergency department.
Department Visit settings.
Visit Type Description Typical Setting
Remote evaluation via Virtual platforms (Zoom,
Telehealth Visit
audio/video communication. Epic, Doximity, etc.)
Temporary hospital stay
Observation Visit Outpatient hospital.
under observation status.
Home Patient care provided at Patient’s residence or
Health/Nursing home or facility. nursing home.
Facility Visit
, 4
6. Importance of Accurate E/M Coding
• Ensures proper reimbursement for provider time and skill.
• Reduces risk of downcoding/overcoding penalties.
• Supports audit readiness and regulatory compliance.
• Reflects true complexity and intensity of patient care.
□ 1. Overview of CPT® System
CPT® (Current Procedural Terminology) is a standardized coding system
developed and maintained by the American Medical Association (AMA).
It is used to describe medical, surgical, and diagnostic services provided by
healthcare professionals. CPT codes serve as the foundation for:
• Reimbursement
• Claims processing
• Medical documentation standardization
• Healthcare analytics and compliance
2. Structure of CPT® Codes
Each CPT code is 5 digits, and every digit or range represents a specific
category of service. The structure includes:
• Category I: Regular medical procedures and services.
• Category II: Performance and quality tracking codes.
• Category III: Emerging technology, experimental, or research-based
procedures.
3. CPT® E/M Code Ranges (99202–99499)
TRAINING DOCUMENT ON E/M MEDICAL
CODING-2026 JUST RELEASED UPDATED
STUDY GUIDE RELEVANT TO ACTUAL
SITTING EXAM
1. What is E/M Coding?
Evaluation and Management (E/M) services are used by physicians and
qualified healthcare professionals (QHPs) to report patient encounters that
involve:
• Evaluating the patient’s health condition.
• Making clinical decisions.
• Managing treatment and follow-up care.
E/M codes describe the cognitive (non-procedural) portion of patient care—
covering the time and medical decision-making involved in the visit.
2. Purpose of E/M Coding in Healthcare
Purpose Description
E/M codes determine the amount providers get paid for
Reimbursement
patient evaluation and decision-making services.
Documentation Ensures consistent recording of patient encounters
Standardization across all specialties and payers.
Supports medical necessity, coding accuracy, and
Compliance
adherence to CMS and payer guidelines.
Used in value-based care models to measure provider
Quality
Measurement performance and patient outcomes.
,2
3. CPT® Code Structure Overview
E/M codes fall under Category I CPT codes (99202–99499), published by the
American Medical Association (AMA).
CPT Section Range Description
For new and established
Office/Outpatient 99202–99215
Services patients seen in an office or
clinic setting.
Used for initial and subsequent
Hospital Inpatient 99221–99239
Services hospital care.
CPT Section Range Description
99242–99245 For consultations requested by
Consultations
(outpatient), another provider.
99252–99255
(inpatient)
Emergency For services provided in an ER,
99281–99285
Department (ED) regardless of new/established
Services status.
For short-term hospital
Observation Services 99218–99236
stays before admission or
discharge.
For life-threatening conditions
Critical Care Services 99291–99292
requiring complex decision-
making.
Nursing Facility & For patients in nursing homes,
99304–99350
Home Services domiciliary, or home settings.
For remote patient encounters
Telehealth/Virtual 99441–99443, 99421–
Care 99423 via phone or video.
,3
□ 4. Key E/M Components (Pre-2023 Guidelines)
Historically, E/M code levels were based on:
1. History (HPI, ROS, PFSH)
2. Examination (extent of physical exam)
3. Medical Decision Making (MDM)
However, 2023+ AMA Guidelines simplified this for Office/Outpatient services
— focusing only on:
• MDM (Medical Decision Making), or
• Total Time Spent on the date of service.
□ 5. Common E/M Visit Types
Visit Type Description Typical Setting
Routine follow-up or new
Office/Outpatient Clinics, physician offices.
Visit patient evaluations.
Hospital Visit Initial or subsequent hospital Inpatient hospitals.
care.
Emergency
Acute care provided in ER Emergency department.
Department Visit settings.
Visit Type Description Typical Setting
Remote evaluation via Virtual platforms (Zoom,
Telehealth Visit
audio/video communication. Epic, Doximity, etc.)
Temporary hospital stay
Observation Visit Outpatient hospital.
under observation status.
Home Patient care provided at Patient’s residence or
Health/Nursing home or facility. nursing home.
Facility Visit
, 4
6. Importance of Accurate E/M Coding
• Ensures proper reimbursement for provider time and skill.
• Reduces risk of downcoding/overcoding penalties.
• Supports audit readiness and regulatory compliance.
• Reflects true complexity and intensity of patient care.
□ 1. Overview of CPT® System
CPT® (Current Procedural Terminology) is a standardized coding system
developed and maintained by the American Medical Association (AMA).
It is used to describe medical, surgical, and diagnostic services provided by
healthcare professionals. CPT codes serve as the foundation for:
• Reimbursement
• Claims processing
• Medical documentation standardization
• Healthcare analytics and compliance
2. Structure of CPT® Codes
Each CPT code is 5 digits, and every digit or range represents a specific
category of service. The structure includes:
• Category I: Regular medical procedures and services.
• Category II: Performance and quality tracking codes.
• Category III: Emerging technology, experimental, or research-based
procedures.
3. CPT® E/M Code Ranges (99202–99499)
