NextGen Knowledge Center

Overview of Evaluation and Management Coding

You can calculate and submit the E&M code.

You can submit and calculate the Evaluation and Management (E&M) code from the Finalize template using the 95, 97, 2021 Guideline, or 2023 Coding Guidelines update based on the Practice Configuration template settings. The available E&M codes vary by specialty and visit type. If you do not want to charge a patient encounter, you can select the No Charge Visit check box in the Evaluation and Management Coding panel to submit a no-charge code. The No Charge Visit procedure group check box is configured by default. The No Charge Visit check box is enabled only if the no charge SIM code is configured to the No Charge Visit procedure group using the Manage Procedure Group and Codes template. For more information, go to NextGen Healthcare Success Community, and download the latest Manage Procedure Groups and Codes Practice Template forNextGen®Adaptive Content Engine.

The 95 and 97 Coding Guidelines use the following E&M code calculation criteria:
  • History and physical exam elements that are documented on templates and the selected Medical Decision Making (MDM) level.
  • Total visit time if more than 50 percent of the time is spent on counseling or coordinating care.
When you select the 2021 Coding Guidelines on the Practice Configuration template, you must also select the 95 or 97 Coding Guidelines for use with visit types and encounters that do not fall under the 2021 Coding Guidelines.
The 2021 Coding Guidelines use the following E&M code calculation criteria:
  • MDM level selected.
  • Total time spent on patient care and documentation for the visit, which includes the face-to-face time with the patient, and time personally spent by the physician and/or other qualified healthcare professionals on the day of the encounter.

    The 2021 Coding Guidelines apply to certain visit types that use codes 99202-99205 for a new patient and 99211-99215 for an established patient. Code 99201 has expired effective January 1, 2021.

The 2023 E&M Coding Guidelines updates include most of the E&M codes from various visit types and are now inclusive of the 2021 E&M guidelines. For example, Consult, Home Visit, Domiciliary Visit, Nursing Facility care, Emergency Department, Inpatient, and so on. A few E&M codes are removed and redirected to the existing visit type codes. For example, Observation Care, Prolonged Service, and so on.

For more information on E&M coding, go to NextGen Healthcare Success Community, and download the latest E&M Coding User Guide forNextGen®Adaptive Content Engine.