E & M Billing Guidelines

Evaluation and Management: Billing the Correct Level of Service

In a 2012 study report, the Office of the Inspector General (OIG) noted that a number of physicians increased their billing of higher level, more complex and expensive Evaluation and Management (E/M) codes. Many providers submit claims coded at a higher or lower level than the medical record documentation supports. Use the following resources to bill correctly for E/M services:

• OIG Report: Coding Trends of Medicare E/M Services
• Medicare Claims Processing Manual: Chapter 12, Section 30.6
• E/M Services Guide
• 1995 Documentation Guidelines for E/M Services
• 1997 Documentation Guidelines for E/M Services
• Frequently Asked Question on Use of 1995 and 1997 Guidelines