Evaluation & Management Services
OFFICE OR OTHER OUTPATIENT
E/M SERVICES
, E/M Guidelines Overview
Evaluation and management guidelines have sections common to all
E/M categories and sections that are category specific.
Types of Categories: Office visits, Hospital visits, and Consultations.
(GREEN headings in Evaluation and Management Section)
Types of Subcategories: New and Established patients, Initial hospital
care, Subsequent care, and Discharge services.
(RED headings in Evaluation and Management Section)
Two sets of Guidelines and Auditing tools
1. Office or Other Outpatient Services (2021)
2. Other E/M Services (1995 and 1997)
The differences between 1995 and 1997 is how the examination level
is determined. 1997 does not have an History/MDM section, so you
will need to bring all three auditing tools for CPC exam. If you get a
higher level for exam with 1997 than 1995 — go with 1997.
What is the difference between the two sets of guidelines?
Office or Outpatient Services: Use MDM or Time as the basis for
selecting a code level. (Note: Physicians or qualified health care
professionals should still document history and exam elements, even
though they are not needed for code selection.)
Other E/M Services: Use history, examination, and MDM. Only use
Time when counseling and/or coordination of care dominates the
service.
OFFICE OR OTHER OUTPATIENT
E/M SERVICES
, E/M Guidelines Overview
Evaluation and management guidelines have sections common to all
E/M categories and sections that are category specific.
Types of Categories: Office visits, Hospital visits, and Consultations.
(GREEN headings in Evaluation and Management Section)
Types of Subcategories: New and Established patients, Initial hospital
care, Subsequent care, and Discharge services.
(RED headings in Evaluation and Management Section)
Two sets of Guidelines and Auditing tools
1. Office or Other Outpatient Services (2021)
2. Other E/M Services (1995 and 1997)
The differences between 1995 and 1997 is how the examination level
is determined. 1997 does not have an History/MDM section, so you
will need to bring all three auditing tools for CPC exam. If you get a
higher level for exam with 1997 than 1995 — go with 1997.
What is the difference between the two sets of guidelines?
Office or Outpatient Services: Use MDM or Time as the basis for
selecting a code level. (Note: Physicians or qualified health care
professionals should still document history and exam elements, even
though they are not needed for code selection.)
Other E/M Services: Use history, examination, and MDM. Only use
Time when counseling and/or coordination of care dominates the
service.
