E/M Examination Criteria

Aka: E/M Examination Criteria, E/M Problem Focused Exam, E/M Expanded Problem Focused Exam, E/M Detailed Exam, E/M Comprehensive Exam

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II. Exam: Vital Signs (3 of 8 are required to count as one exam component)

  1. Temperature
  2. Blood Pressure (sitting or standing)
  3. Blood Pressure (supine)
  4. Heart Rate
  5. Respiratory Rate
  6. Oxygen Saturation
  7. Height
  8. Weight

III. Exam: Systems (12)

  1. Vital Signs
  2. Constitutional
  3. Eyes
  4. Ears, Nose, Throat
  5. Cardiovascular
  6. Respiratory
  7. Gastrointestinal
  8. Genitourinary
  9. Musculoskeletal
  10. Skin (integument, includes Breasts)
  11. Neurologic
  12. Psychiatric
  13. Hematologic or Lymphatic

IV. Type: Problem Focused Exam

  1. Criteria: 1 to 5 components
    1. Limited to affected body area or organ system
  2. Related Codes
    1. E/M New Outpatient Visit
      1. CPT 99201
    2. E/M Established Outpatient Visit
      1. CPT 99212
    3. E/M Emergency Services
      1. CPT 99281
    4. E/M Consultation Services
      1. CPT 99241

V. Type: Expanded Problem Focused Exam

  1. Criteria: 6 to 11 components
    1. Affected body area or organ system
    2. Other symptomatic or related organ systems
  2. Related Codes
    1. E/M New Outpatient Visit
      1. CPT 99202
    2. E/M Established Outpatient Visit
      1. CPT 99213
    3. E/M Emergency Services
      1. CPT 99282
      2. CPT 99283
    4. E/M Consultation Services
      1. CPT 99242

VI. Type: Detailed Exam

  1. Criteria: 12 components (11 of 12 systems and vitals signs)
    1. Extended examination of affected body areas
    2. Other symptomatic or related organ systems
  2. Related Codes
    1. E/M New Outpatient Visit
      1. CPT 99203
    2. E/M Established Outpatient Visit
      1. CPT 99214
    3. E/M Emergency Services
      1. CPT 99284
    4. E/M Consultation Services
      1. CPT 99243

VII. Type: Comprehensive Exam

  1. Criteria: 13 components (all systems and vitals signs)
    1. Complete single system specialty examination or
    2. Complete multi-system examination
  2. Related Codes
    1. E/M New Outpatient Visit
      1. CPT 99204
      2. CPT 99205
    2. E/M Established Outpatient Visit
      1. CPT 99215
    3. E/M Emergency Services
      1. CPT 99285
    4. E/M Consultation Services
      1. CPT 99244
      2. CPT 99245

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