E/M (Evaluation and Management)

Evaluation and Management (E/M) codes (99202–99215) are used when a prescribing clinician (psychiatrist, psychiatric NP) performs a medical assessment on the same day as psychotherapy. To bill both an E/M and a psychotherapy code on the same date, the E/M must be significant and separately identifiable from the psychotherapy — evidenced by the -25 modifier on the E/M code. Omitting -25 is the leading cause of CO-97 (bundled service) denials. The +25 modifier conflict is the most litigated billing issue in combined psychiatric-therapy billing.