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E/M Coding and the Documentation Guidelines: Putting It All Together
Evaluation and management (E/M) services refer to diagnostic/therapeutic management of the patient furnished by healthcare providers. The Center for Medicare and Medicaid Services (CMS) has found E/M services vulnerable to fraud and abuse. Scrutiny from the OIG, government-contracted, and third-party auditors makes it especially important to keep your E/M coding skills current and up to date.
CMS requires healthcare providers to accurately determine the appropriate complexity level of an E/M service, corresponding to the amount of skill, effort, time, responsibility, and medical knowledge required for the healthcare provider to deliver the service to the patient. In addition to the AMA & CMS guidelines for E/M code selection, there are also various policies, coverage determinations, and requirements that must be considered for each major payor.
This course is relevant for providers, clinical, and practice staff involved in diagnostic and procedural coding, medical coders, consultants and office managers are encouraged to attend. Learn coding rules and documentation guidelines relevant to proper E/M code selection. Attend this informative session to master the process of accurately determining the appropriate E/M code level for services and improve your understanding of the criteria that are utilized in making the determination.
The instructor will bring clarity to distinctions regarding new vs. established patient guidelines and coding E/M services based on time vs Medical Decision Making (MDM). Find out what non-face to-face work is to be included in total time and gain details on the time ranges. Learn when and how to use the CPT prolonged services code(s) and when to use office and outpatient visit codes without an add-on prolonged care code based on time.
Highlights:
- Review essential coding guidelines for E/M services to ensure proper claims submission
- Understanding the role of history and exam
- Medical Necessity and Nature of the Presenting Problem
- Coding based on time; what is included and excluded?
- Review reporting rules for prolonged services
- Receive coding tips and strategies for successful documentation and claims submissions
Full Schedule
Program times are Central unless otherwise noted.
| Session | Date | Time | Instructor | |
| 1 | July 10, 2025 | 11:00 am-2:00 pm | Jan Hailey | |
| Fee: $239.00 | Register | |||
Can't attend a live session? Register anyway and you'll receive a link to the recording by the next business day. | ||||
CEUs:
| PMI | 3 |
Target Audience
This course is appropriate for providers, clinical, and practice staff involved in diagnostic and procedural coding. Beginning and certified coders alike will benefit from this course. Consultants and office managers are also encouraged to attend.
About the Presenter
Jan Hailey MHL, CMC, CMCO, CMIS, CMOM, CMCA E/M
Jan Hailey has more than 30 years of experience in healthcare. She is proficient in administration, coding, and billing roles, and teaches medical office professionals around the country how to excel in their careers. Jan has also been instrumental in the development of PMI's Workforce Initiatives program.
Jan's affinity for teaching has helped countless healthcare providers and medical office professionals over the years. During her expansive career, she has served as Director of Quality for Saint Joseph Physician Network located in Mishawaka, IN, and Director of Care Management with Select Health Network, an entity of Saint Joseph Health System. As Care Management Director, Jan led the physician network and comprehensive interdisciplinary team across the health system working closely with providers, management, staff, community, and payers to develop strategies for process improvement, gap closures, and patient experience. She developed a documentation improvement program and a Hierarchical Condition Category (HCC) coding education program to predict future healthcare utilization by accurately reporting patient complexity.
Prior to joining Saint Joseph, Jan was the Director of Quality, Coding, and Compliance for one of the largest health systems in Northern Indiana. She has a Master of Health Leadership and four professional certifications in office management, coding, insurance processing, and compliance. She is a member of WPS Government Health Administrators (Medicare) Provider Outreach and Advisory Group.