Evaluation and management services in the Resource-Based Relative Value Scale
P. Braun, W. C. Hsiao, E. R. Becker and M. DeNicola
Department of Health Policy and Management, Harvard University School of Public Health, Boston, MA 02115.
Evaluation and management (E/M) services, which include making diagnoses,
counseling and educating, developing strategies of care, and following up
on treatment, are common to all medical specialties. Surveys of a variety
of specialists using the magnitude-estimation method show that physicians
agree closely in rating the work of particular E/M services. Regardless of
the type of E/M service, the site at which it is performed, or the
specialty performing it, work per unit of time varies only slightly.
Comparison of work and time for services to which experts assigned billing
codes in our consultative process indicates, however, that there may be
large differences in the way different specialties use these billing codes.
In some instances, work entailed by some of the E/M billing codes within
specialties also appears to vary substantially. If empirical studies of
physicians' coding and billing practices support our findings, possible
responses might include (1) developing specialty-specific resource-based
relative values for E/M services and (2) redefining the Physicians' Current
Procedural Terminology, edition 4, codes for these services in terms that
include time specifications.
