Documentation Guidelines for Evalution and Management Services
Last Updated: Thursday, May 16, 2024
What’s New in 2024
Effective January 1, 2024, the Office and Outpatient Evaluation and Management (E/M) Coding Guidelines were updated to remove the time ranges from new and established outpatient codes. The time that needs to be met is now the lowest number of minutes in the current code range. This change applies to the following code sets:
- Office or Outpatient visit 99202-99205 and 99212-99215
In addition, the minimum time values for nursing facility care codes increased by five minutes each. This change applies to the following codes:
- Nursing Facility Service codes 99306 and 99308
2024 Resource Links
Documentation Guidelines for E/M Services 2024
Auditor’s Scoring Worksheets:
- Emergency Department E/M Services 2024
- Hospital Inpatient or Observation Care E/M Services 2024
- Nursing Facility and Home or Residence E/M Services 2024
- Outpatient E/M Services 2024
*Please refer to Reimbursement Policy RP-063 for additional information related to Consultation Services.
2023 Office and Outpatient Evaluation and Management Resources
In alignment with the Office and Outpatient Evaluation and Management (E/M) Coding Guidelines changes that were effective January 1, 2021, the following code sets were revised effective January 1, 2023:
- Non-Office E/M codes (99221-99223, 99231-99239)
- Consultation codes (99242-99245, 99252-99255)*
- Emergency Department codes (99281-99285)
- Nursing Facility Service codes (99304-99310, 99315, 99316)
- Home or Residence Service codes (99341, 99342, 99344, 99345, 99347-99350)
Except for Emergency Department codes (99281-99285), providers may choose the appropriate E/M level of care based on either Time or Medical Decision Making (MDM). Emergency Department codes (99281-99285) use only MDM to determine level of care.
Please see the Documentation Guidelines for E/M Services 2023 for additional details on how to correctly report these services.
2023 Resource Links
Auditor’s Scoring Worksheets:
- Emergency Department E/M Services 2023
- Hospital Inpatient or Observation Care E/M Services 2023
- Nursing Facility and Home or Residence E/M Services 2023
- Outpatient E/M Services 2023
Frequently Asked Questions (revised)
*Please refer to Reimbursement Policy RP-063 below for additional information related to Consultation Services.
2021 Office and Outpatient Evaluation and Management Resources
Prior to 2021 Evaluation and Management Resources
(Note: These guidelines will not be in effect for any E/M services as of January 1, 2023.)
Below you will find the Documentation Guidelines that were effective prior to 2021 for office and outpatient E/M services and effective prior to 2023 for all other E/M services:
