Coding E&M Visits

E&M services make up the bulk of the work you do as a pediatrician. They represent the cognitive work, information gathering, and decision making that goes into a patient encounter. More than any other specialists, pediatricians’ time with patients is going to be classified as an E&M. Because most of the work you do falls under the umbrella of E&M, it’s vital that you code those services correctly. Many pediatricians under-code their encounters, resulting in sometimes significant amounts of lost revenue for their practice.

Based on PCC client data, average payment for the 99214 E&M code is about 40% more than the average payment for the 99213 code. Average payment for the 99215 code is about twice as much as the average payment for the 99213 code!

Coding your E&M services correctly is not only a matter of revenue. The requirements for documenting each level are also intended to provide appropriate and adequate information for continuity of care.

The following resources are intended to help you evaluate and understand E&M coding:

PCC’s One-Page E&M Coding Guide

PCC created a one-page printable guide to use to facilitate accurate E&M leveling.

PCC E&M Training Videos

By watching this video series, you can learn about the E&M coding process. The videos include examples and tips that you can apply to your daily workflow.

Evaluate Your Practice’s E&M Habits and Patterns

Your Practice Vitals Dashboard, available from within PCC EHR, provides a number of metrics, tools and recommendations related to E&M coding included on the “E&M Coding Distribution” measure.

Confessions of a Pediatric Practice Management Consultant (formerly “Chip’s Blog”)

PCC’s Chip Hart runs a blog and podcast, covering many topics related to practice management, including E&M coding. You can find it here.

  • Last modified: June 16, 2017