What is E/M Coding?
Also called: evaluation and management · office visit levels
Medical decision making is scored across three elements: the number and complexity of problems addressed, the amount and complexity of data reviewed, and the risk of complications from management decisions. Two of three elements determine the level.
The time alternative counts total practitioner time on the date of service, including chart review, documentation and care coordination — not just face-to-face time. Many practices under-code by continuing to count only the visit itself.
Where Vizora handles this
Primary sources
Where "E/M Coding" is defined by the bodies that set the rules, rather than by us.
- Evaluation and Management services guide (opens in a new tab)
Centers for Medicare & Medicaid Services — How E/M level is determined under the current medical decision making and time rules. The reference for any dispute about whether documentation supports a level.
- CPT code set (opens in a new tab)
American Medical Association — Maintainer of CPT. Annual changes to CPT are the most common cause of a sudden, unexplained rise in denials each January.
- OIG Work Plan (opens in a new tab)
HHS Office of Inspector General — What the OIG has said it will audit and when. The clearest available signal of which coding patterns are about to receive attention.
Last reviewed August 20, 2026
Related terms
CPT Code
A CPT code is a five-character code maintained by the American Medical Association that identifies the procedure or service a provider performed. CPT answers what was done; ICD-10-CM answers why. Together they establish medical necessity, and a mismatch between them is a leading denial cause.
Medical Necessity
Medical necessity is a payer's determination that a service was appropriate for the patient's condition under its coverage policy. It is established by the pairing of diagnosis and procedure codes and supported by the documentation — which means a medically necessary service can still be denied if the coding does not demonstrate it.
Undercoding
Undercoding is billing a lower-level or less specific code than the documentation supports. It produces no denials, triggers no alerts and appears nowhere in a standard revenue report — which makes it the least visible and most persistent form of revenue leakage in a physician practice.
Modifier
A modifier is a two-character suffix appended to a CPT or HCPCS code that alters its meaning without changing the code itself — signalling that a service was distinct, bilateral, repeated, reduced or performed by a specific provider role. Modifiers are how correct coding survives contact with bundling edits.
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