Evaluation and Management (E/M)
Evaluation and Management (E/M) codes report office visits, hospital visits, and other encounters where a provider assesses and manages a patient's condition.
Updated
Evaluation and Management (E/M) codes are a category of CPT codes that report encounters in which a provider evaluates a patient's condition and makes management decisions — office and outpatient visits, hospital inpatient visits, emergency department services, consultations, and similar encounters. They are among the most frequently billed CPT codes and a major share of professional revenue.
E/M code selection is based on the level of the encounter, which for most office and outpatient services is determined by either medical decision-making or total time spent, along with the patient's status (new vs. established, where applicable). Documentation must support the level reported, and the rules for level selection have been revised over time.
In practice
Because E/M codes are volume-heavy and payment varies by level, accurate level selection and supporting documentation are recurring audit and denial targets. The same visit reported at the wrong level — over- or under-stated — is a common cause of payment error and post-payment review.
Commonly confused with
- CPT code: E/M codes are a category within the CPT code set; CPT also includes procedure, surgery, and other categories. An E/M code reports the encounter; a procedure CPT reports a specific service performed.