evaluation and management
eam_cdDefinition
ISO-11179 Definition
The category of CPT procedure codes used to report physician and qualified healthcare professional services involving the cognitive work of patient assessment, medical decision-making, and care planning across office visits, hospital visits, consultations, and other encounter types. Evaluation and management codes are the most frequently billed and most audited professional service codes in Medicare and commercial insurance, representing the majority of physician reimbursement for cognitive services. CMS revised E/M documentation and coding guidelines effective January 2021 to base office visit level selection on medical decision-making complexity or total time spent rather than the prescriptive history and physical examination element counting required under previous guidelines.
Correct E/M code level selection requires documentation supporting the billed complexity level. Healthcare data teams analyze eam_cd distribution patterns by provider and specialty to identify coding outliers, measure the revenue impact of documentation improvement initiatives, and support E/M compliance audit programs.
Standard Abbreviation
eam_cd
Category
Production DDL — FACT_CLAIM_TRANSACTION
CREATE OR REPLACE TABLE FACT_CLAIM_TRANSACTION (
clm_txn_key INTEGER NOT NULL -- surrogate key,
clm_id VARCHAR(50) NOT NULL -- claim identifier,
mbr_key INTEGER NOT NULL -- FK to DIM_MEMBER,
prvdr_key INTEGER NOT NULL -- FK to DIM_PROVIDER,
clm_typ_cd VARCHAR(10) -- claim type code,
tot_chrg_amt DECIMAL(18,2) -- total charged amount,
tot_alwd_amt DECIMAL(18,2) -- total allowed amount,
tot_pd_amt DECIMAL(18,2) -- total paid amount,
cntrct_adj_amt DECIMAL(18,2) -- contractual adjustment,
denial_ind CHAR(1) -- denial indicator,
denial_rsn_cd VARCHAR(10) -- denial reason code,
prior_auth_nbr VARCHAR(30) -- authorization number,
clm_lag_days SMALLINT -- claim lag days,
days_ar SMALLINT -- days in AR,
load_dt TIMESTAMP_NTZ NOT NULL -- load timestamp
);
Standard Snowflake DDL for the canonical finance table. Convert to BigQuery or Databricks →
Why This Term Matters
Healthcare data terminology is foundational for any data engineer working in this industry. Precise understanding of standard terms enables accurate schema design, reduces downstream data quality issues, and ensures pipelines meet the regulatory and interoperability requirements imposed by HIPAA, HL7 FHIR, and CMS reporting frameworks. Without this foundation, even technically well-built pipelines produce data that fails validation when it reaches payers or regulators.
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