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By Kacie Geretz, Director of Growth Enablement
September 11, 2025
Key Takeaway: With 2025 E/M coding guidelines emphasizing medical decision-making over previous criteria and introducing 16 new telehealth codes (98000-98015), healthcare providers face significant compliance challenges. This guide explores the major changes affecting primary care, inpatient services, and telehealth billing, plus reveals how Nym's autonomous medical coding engine automatically adapts to guideline updates in real-time through proprietary CLU technology, eliminating manual interpretation errors while maintaining 95%+ accuracy and delivering actionable compliance insights.
Every year, the American Medical Association updates the Current Procedural Technology (CPT) code. Healthcare providers need to stay current with these annual guidelines to ensure precise medical records, streamlined billing, and accurate reimbursement.
Keeping track of what's changed and what stayed the same from the previous year's code can be tricky, especially with evaluation and management coding guidelines. The 2025 E/M coding guidelines cheat sheet will help medical coders, healthcare providers, and billing teams understand the relevant guideline changes in 2025.
Several aspects of the E/M coding guidelines changed from 2024 to 2025, especially regarding audio-visual and audio-only telehealth services. At the end of 2024, E/M reporting flexibility expired, and regulations for telehealth coding went back to what they were prior to COVID-19 waivers (1). There are now several new telemedicine services E/M codes, 98000 to 98015, that follow the same code pattern selection as the corresponding in-person E/M codes (2).
Note: As of publication, Medicare coverage for the new telehealth codes 98000-98015 remains under review, while some commercial payers and Medicaid plans have begun accepting them (2). Healthcare providers should verify acceptance with each payer before implementing these codes.
As of 2025, medical decision-making (MDM) is the primary coding criterion for selecting the correct E/M codes (3). While time spent with the patient and the extent of the history and examination are still relevant to code selection, MDM carries more weight. Primary care providers, inpatient and observation care, and telehealth providers will be among those most affected by the 2025 changes to the E/M coding guidelines.
Telemedicine Services is a new subsection of the CPT code for 2025 with codes 98000 to 98015 (2). The coding and documentation requirements for these new codes align with the corresponding in-person E/M codes, which can simplify matters for healthcare providers (2).
When coding by MDM, the new codes are (2):
The 2025 updates also introduced a new E/M code, G5045, which can be used in conjunction with hospital codes 99211 to 99239 and covers inpatient services for patients with confirmed or suspected conditions (4).
While not new for 2025, Complex Chronic Care Management (CCM) is still reported with CPT 99487 and 99489:
CMS guidelines reinforce these rules, making it important to distinguish CCM from standard E/M coding.
It's easy for healthcare teams to get overwhelmed trying to keep up with E/M coding guideline changes, and the stakes are high. Without accurate coding, providers can struggle to have their claims processed efficiently and receive accurate reimbursement. Most coding solutions require manual training and updates when guidelines change, creating potential gaps in compliance during transition periods.
Traditional autonomous coding solutions across the industry typically face significant challenges when coding guidelines are updated. Many require lengthy retraining processes, manual rule adjustments, or system downtime while new guidelines are integrated. This creates compliance risks during transition periods and places additional administrative burden on coding teams.
While most autonomous coding solutions in the industry require manual updates when guidelines change, Nym's autonomous medical coding engine automatically adapts to rule changes in real-time through its proprietary Clinical Language Understanding (CLU) technology. Unlike traditional computer-assisted coding that still requires human validation, Nym's CLU-powered engine makes coding decisions independently and passes coded charts directly to billing with complete transparency and comprehensive audit trails.
This approach enables healthcare teams to maintain compliance with evolving guidelines like the 2025 E/M updates without manual intervention, while providing fully explainable coding decisions for every code assignment.
Learn more about Nym's autonomous medical coding engine
Updated E/M coding guidelines for 2025 include new codes for audio/visual and audio-only telemedicine services. For example, 98000 is the new audio/visual code for a telehealth appointment with a new patient and straightforward MDM (5). The new coding guidelines also place greater emphasis on medical decision-making than previous guidelines (3).
Healthcare teams should familiarize themselves with the new coding standards, paying close attention to documentation rules that have changed since the previous year. Beyond continuous training, using the right tools can make all the difference in ensuring compliance. While most autonomous coding solutions require manual updates and retraining when guidelines change, Nym's CLU-powered engine automatically applies the most recent coding guidelines to patient charts going forward, ensuring compliance without additional human involvement.
While AI-powered medical coding programs can assist with E/M coding, human coders typically still need to review, approve, or oversee the coding process across most industry solutions. By contrast, Nym's autonomous coding engine can assign the right E/M codes to applicable patients' charts and send those charts to billing without human intervention, processing charts in seconds compared to traditional manual coding times while providing complete audit trails for compliance validation.
Kacie Geretz, RHIA, CPMA, CPC, CCA is the Director of Growth Enablement at Nym, where she aligns Nym’s product roadmap with the evolving needs of health system partners and serves as the externally-facing expert on Nym’s autonomous medical coding engine. A graduate of The Ohio State University’s Health Information Management program, Kacie brings deep expertise across the revenue cycle—having led revenue integrity programs, built managed care contracting and credentialing infrastructure, and driven denials and A/R process improvement initiatives. She is passionate about advancing healthcare automation and regularly shares insights on coding innovation and RCM transformation.
