Introduction

Evaluation and management (E/M) services refer to visits furnished by physicians and qualified, licensed, non-physician practitioners. Billing Medicare for a patient visit requires the selection of the code that best represents the level of E/M service performed.

The purpose of this interactive worksheet is to assist providers with identifying the appropriate E/M code based upon either the:

• 1995 or 1997 Documentation guidelines for evaluation and management services, or
• AMA CPT E/M code guideline changes for 2021 (effective for office and outpatient visits for dates of service on and after January 1, 2021), or
• E/M code and guideline changes for 2023 (effective for other E/M visits for dates of service on and after January 1, 2023).

Effective January 1, 2023, the AMA CPT editorial panel approved revised coding and updated guidelines for "Other E/M visits" (which includes hospital inpatient, hospital observation, emergency department, nursing facility, home or residence services, and cognitive impairment assessments). CMS adopted most of the CPT’s revised guidance, including deletion of several CPT codes.

Effective for dates of service (DOS) on and after January 1, 2023, practitioners have the choice to document most E/M visits via medical decision making (MDM) or time, except emergency department visits and cognitive impairment assessments, which are not timed services.

The E/M code and guideline changes are like those already applied to office and other outpatient visits, which were effective for dates of service on and after January 1, 2021.

CMS requires that any Medicare service provided or ordered must be authenticated by the author -- the one who provided or ordered that service. Before completion of the E/M worksheet is initiated, verification that this requirement has been fulfilled is completed. Next, before beginning an E/M interactive worksheet session, you must first accept the terms of the E/M interactive worksheet, the user agreement. Although the E/M interactive worksheet was created as a resource to assist providers with selecting the appropriate E/M code, it is not intended to serve as a replacement for the E/M documentation guidelines published by CMS, AMA CPT E/M code guideline changes for 2021 (effective for office / outpatient visits only for dates of service on and after January 1, 2021), or AMA CPT code and guideline changes for 2023 (effective for other services on and after January 1, 2023.

Note: Once you have responded that documentation for services billed includes the date and legible signature of the rendering provider, you will be asked to acknowledge and accept the terms of the user agreement. Once accepted, you will gain immediate access to the E/M interactive worksheet.