Evaluation_and_Management[1]

Building an E/M Code

The Basics of Evaluation & Management Services

Department of Revenue Integrity

Charting History Medical records tell a story about a patient’s care

and treatment. Whether it’s a fifteen minute consultation or a weeklong hospital stay, all of the time a patient is seen by someone in healthcare, is tracked.

Medical record documentation is required to record pertinent facts, findings and observations about an individual’s health history, including past and present illnesses, examinations, tests, treatments and outcomes.

It’s imperative that as coders, we read through the documentation and accurately pick up certain pieces so that we can determine a level of visit.

By laying brick upon brick, buildings are built. We do the same with our E/M codes by adding together elements from documentation to support a level of visit.

E/M Factors to consider

Type of service (TOS)Visit, consult, observation?

Place of service (POS)Emergency room, office, inpatient hospital, outpatient hospital, etc.

Patient Status New vs. Established

Patient status

A coder should be able to determine from the medical record whether or not the patient is NEW or ESTABLISHED.

CPT defines a new patient as “one who HAS NOT received any professional services from the physician or another physician of the same specialty who belongs to the same group practice, within the past three years.”

An established patient is “one has HAS received professional services from the physician or another physician of the same specialty who belongs to the same group practice, within the past three years.”

You’ll also notice in CPT that new patients require 3/3 key components, whereas established patients require 2/3. This determination is based on work performed and prior knowledge of the patient and their needs.

New patient visits

Established patient visits

Places of service

There are many different places of service for patients to be seen:Offices, hospitals (inpatient and outpatient), observation, emergency departments, nursing facilities, domicilaries, and patient’s homes.

By locating the place of service, it determines a certain range of codes and rules out a group that cannot be reported.

Components that make up E/M services

Key Components:

History

Examination

Medical Decision Making

Contributory Components:

Counseling

Coordination of Care

Nature of presenting problem (illness)

Time

Key Components

History

Examination

Medical Decision Making

Office or other outpatient services

Hospital observation servicesHospital inpatient servicesConsultationsEmergency Department services, Nursing facility services,Domiciliary care servicesHome Care Services

Key Component: History

The history element is made up of four types of history:

Chief Complaint (CC) History of Present Illness (HPI) Review of Systems (ROS) Past, Family & Social History (PFSH)

HISTORY: Chief Complaint (CC)

Defined as “a concise statement describing the symptom, problem, condition, diagnosis, or other factor that is the reason for the encounter, usually stated in the patient’s own words”.

A chief complaint must be present in all charts to count toward an E/M level of service.

HISTORY: Chief Complaint (cont.)

Examples: “Patient presents for follow-up of

fracture care…” “38-year old female is complaining of

build-up of ear wax…” “17-year old male was in high-speed MVA

and is complaining of headache, neck pain and shoulder pain.”

HISTORY: History of Present Illness (HPI)

Defined as a “chronological description of patient’s present condition from time of onset to present”.

May not always include a timeline of events May not be stated in the patient’s own words if

unable to speak (i.e. CVA, trauma, etc.) Clues can be given by family or other medical

personnel present at scene if trauma Includes eight description terms that may be met

when calculating the HPI

HISTORY: HPI Descriptors

Location Severity Duration Associated Signs/Symptoms Quality Context Timing Modifying Factors

HISTORY: HPI Location WHERE on the body the

symptom is occurring i.e. chest pain i.e sore throat i.e. knee swellingSome questions physicians

will ask are: Is the pain diffuse or

localized? Unilateral or bilateral? Fixed or migratory? If documented, give one

point for location.

HISTORY: HPI Severity

A rank of the symptom/pain on a scale from 1-10.

May also be described as severe, slightly, “worst I’ve ever had”, mild, moderate, increasing, decreasing, progressive, well.

If documented, give one point for severity.

HISTORY: HPI Duration Describes how long the

symptom/pain has been present or how long it lasts when the patient has it

i.e. 20 minutes i.e. 3 years ago i.e. since last Friday i.e. approximately two

months ago i.e. yesterday If documented, give one

point for duration.

HISTORY: HPI Associated Signs/Symptoms

Describes the symptom/pain and other things that happen when this symptom/pain occurs.

i.e. chest pain leads to shortness of breath

Headache leads to visual disturbances

If documented, give one point for associated signs/symptoms.

HISTORY: HPI Quality

Describes the character or type of the symptom/ pain

i.e. sharp i.e. dull i.e. burning If documented, give

one point point for quality.

HISTORY: HPI Context

Describes HOW it happened; situation associated with the pain/symptom

i.e. exercise, dairy products, in an MVA, running down the steps, sitting in a chair

If documented, give one point for context.

HISTORY: HPI Timing

Describes WHEN the pain/symptom occurs or establishes the onset for each symptom (why and when) and a rough chronology of the event(s) surrounding

If documented, give one point for timing.

HISTORY: HPI Modifying Factors

Were medications taken to counter the effects of pain? Did the patient eat or lay down? What was done in an attempt to resolve the issue?

If documented, give one point for modifying factors.

HISTORY: HPI Types

There are two types of HPI and they factor into the E/M level. Notice once you have four elements of HPI, you’re now in the detailed range.

Be careful when counting these.

Brief 1-3 elements

Extended 4+ elements (’95)

OR 3 chronic conditions (’97)

Example of History: HPI

Patient complains of stabbing, intermittent

chest pain which began eight hours ago

while watching television. He rated the pain

as 8/10 in severity and is worse with exertion. It is

also associated with SOB and nausea.

Example Answer

Patient complains of stabbing, intermittent

chest pain which began eight hours ago

while watching television. He rated the pain

as 8/10 in severity and is worse with exertion. It

is also associated with SOB and nausea.

TimingQuality

Location Duration

Context

SeverityModifying factor

Associated S/S

HISTORY: Review of Systems (ROS)

An inventory of body systems obtained through a series of questions, seeking to identify signs and/or symptoms that the patient may be experiencing or may have experienced.

There are fourteen body systems/areas that are covered in this element.

HISTORY: ROS

Constitutional (fever, weight loss, etc.)

Musculoskeletal

Eyes Integumentary (skin and/or breast)

Ears, Nose, Throat Neurological

Cardiovascular Psychiatric

Respiratory Endocrine

Gastrointestinal Hematological/lymphatic

Genitourinary Allergic/ immunological

HISTORY: ROS Types

There are three types of ROS.

Problem focused is not relevant in ROS because to have 1 ROS element, you already are at the expanded problem focused history.

Problem pertinent

Focuses on sole problem

Extended Inquires about the system directly related to the problem (2-9 systems)

Complete Inquires about all systems (10+)

Example of History: ROS

Patient admits to lower back pain, loss of

balance and dizziness. He denies nausea,

vomiting, fever or chills. Also he denies

abdominal pain, urinary frequency, and painful

urination. He further denies chest pain, SOB and

headaches. Does admit to fatigue and anxiety.

Example Answer

Patient admits to lower back pain, loss of

balance and dizziness. He denies nausea,

vomiting, fever or chills. Also he denies

abdominal pain, urinary frequency, and painful

urination. He further denies chest pain, SOB and

headaches. Does admit to fatigue and anxiety.

Musculoskeletal

NeuroGastro

Constitutional

Genitourinary

Cardio

Respiratory

Hemat Psych

Checklist: ROSGEN c/o occ malaise and weight gain

EYES No blurred vision

CVS No CP, DOE, PND, orthopnea, syncope, palpitations

RESP No cough, wheezing, hemoptysis, SOB

GI No N/V/D/C, melena, heartburn, pain

GU No dysuria, urgency, hesitancy, nocturia, incontinence

SKIN No ulcers, itching, dryness, rash

MUSC No joint pain, gait disturbance, cramps

NEURO No confusion, memory loss, seizures, LOC, occ headache

OTHERS Remaining systems are negative

HISTORY: PFSH

PFSH is an abbreviation for past, family and social history which make up the third part of the history element.

These three types of history paint a clearer picture for the physician to help narrow down a specific injury, alert the physician to a need for testing in a certain area, or provide background for medical decision making.

HISTORY: PFSH

Past history (patient’s past experiences with illnesses, operations, injuries and treatments)

Family history (a review of medical events in the patient’s family, including diseases which may be hereditary or place a patient at risk

Social history (age appropriate review of past and current activities)

Social

Family

Past

HISTORY: PFSH Types

There are two types of PFSH.

Problem focused and expanded problem focused are not relevant as they don’t require any of the PFSH types for a certain level to be met.

Pertinent At least 1 item from any of the three areas (must be directly related to HPI)

Complete 2-3 areas

Example of History: PFSH

HPI: Coronary artery disease.

PFSH: Patient returns to office for follow up of CABG in 1992. Recent cardiac catheterization demonstrates 50% occlusion of vein graft to obtuse marginal artery.

Example Answer

HPI: Coronary artery disease.

PFSH: Patient returns to office for follow up of CABG in 1992. Recent cardiac catheterization demonstrates 50% occlusion of vein graft to obtuse marginal artery.

DIRECT RELATION TO HPI

One element

PFSH Requirements NEW Pts:

At least one specific item from EACH of the history areas (past, family AND social history) must be documented for the following categories of E/M services to obtain a comprehensive PFSH.

3/3 Office or other outpatient svcs, new

Hospital observation services

Hospital inpatient services, initial

Comprehensive NF assessments

Domiciliary care, new pt

Home care, new pt

PFSH Requirements EST Pts:

At least one specific item from TWO of the three history areas (past and family, family and social, or social and past) must be documented for a complete PFSH.

2/3 Office or other outpatient services, established

Emergency Department

Domiciliary care, est.

Subsequent NF care

Home care, est.

History Recap

Documentation requirements

Level of Hx

Problem Focused

Expanded Problem Focused

Detailed Comprehensive

HPI 1-3 1-3 4+ 4+

ROS 0 1 2-9 10

PFSH 0 0 1 2/3

Important E/M rules to remember:

Levels do not crosswalk. Some codes are based on time. The chief complaint, ROS and PFSH may

be listed as separate elements of history, or they may be included in the description of the HPI. Pay attention to only pull what is necessary as long as the documentation is provided.

Important E/M rules (cont.)

An ROS and/or a PFSH obtained during an earlier encounter doesn’t need to be re-recorded if there is evidence that a physician reviewed and updated the previous information.

This does NOT mean that copying/pasting is allowed by any physician.

Important E/M rules (cont.)

If the physician is unable to obtain history, from the patient or other source, the reason why should be listed.

Key Component: Examination

An examination is a thorough evaluation from head to toe of a patient, who is presenting with an illness/injury.

There are two kinds of acceptable examinations approved by CMS. They are the 1995 guidelines and the 1997 guidelines. They are made up of body areas and organ systems.

Examination

BODY AREAS

Head (including face)

Neck

Chest (breasts/axillae)

Abdomen

Genitalia, groin, buttocks

Back, spine

Each extremity

Examination ORGAN SYSTEMSConstitutional (e.g., vital signs,

general appearance)EyesEars, nose, mouth, throatCardiovascularRespiratoryGastrointestinalGenitourinaryMusculoskeletalSkinNeurologicPsychiatricHematologic/Lymphatic/

Immunologic

1995 Guidelines:

The levels of E/M services are based on four types of examination that are defined as follows:

https://www.cms.gov/MLNProducts/Downloads/1995dg.pdf

Problem focused Limited exam- affected body area or organ system

Expanded problem focused

Limited exam- affected body area or organ system & other symptomatic or related organ system(s).

Detailed Extended exam- affected body area(s) and other symptomatic or related organ system(s).

Comprehensive Multi-system exam or complete exam of a single organ system

1997 Guidelines:

https://www.cms.gov/MLNProducts/Downloads/MASTER1.pdf

• Problem Focused Examination-should include performance and documentation of one to five elements identified by a bullet (•) in one or more organ system(s) or body area(s).

• Expanded Problem Focused Examination-should include performance and documentation of at least six elements identified by a bullet (•) in one or more organ system(s) or body area(s).

• Detailed Examination--should include at least six organ systems or body areas. For each system/area selected, performance and documentation of at least two elements identified by a bullet (•) is expected. Alternatively, adetailed examination may include performance and documentation of at least twelve elements identified by a bullet (•) in two or more organ systems or body areas.

• Comprehensive Examination--should include at least nine organ systems orbody areas. For each system/area selected, all elements of the examination identified by a bullet (•) should be performed, unless specific directions limit the content of the examination. For each area/system, documentation of at least two elements identified by a bullet is expected.

Differences in Exams:

Problem focused

one body area or organ system

Problem focused

1-5 bulleted elements

Expanded problem-focused

2+ body areas and/or organ systems

Expanded problem focused

6-11 bulleted elements

Detailed


Detailed

12-17 bulleted elements for 2+ systems

Comprehensive


Comprehensive

18+ bulleted elements for 9+ systems

1995 guidelines 1997 guidelines

Key Component: MDM

The last piece that helps determine an E/M is the Medical Decision Making. This piece is a little bit more complex, but relevant to determining a level.

Medical Decision Making Types

Straight forward

Low Moderate High

Complexity of MDM

Two of the three elements must be met or exceeded to qualify for a given type of MDM, or drop to the lowest.

Number of diagnoses or management

options

Amount and/or complexity of

data to be reviewed

Risk of complications

and/or morbidity or mortality

Type of decision making

Minimal Minimal or none

Minimal Straightforward

Limited Limited Low Low

Multiple Moderate Moderate Moderate

Extensive Extensive High High

Number of Dx or Mgmt Options

The number of possible diagnoses and/or the number of management options that must be considered is based on the number and types of problems addressed during the encounter, the complexity of establishing a diagnosis and the management decisions made by the physician.


Generally, decision-making with respect to a diagnosed problem is easier than that for an identified but undiagnosed problem.

The number and type of diagnostic tests employed may be an indicator of the number of possible diagnoses.

Problems which are improving or resolving are less complex than those which are worsening or failing to change as expected.

The need to seek advice from others is another indicator of the complexity.

Amt and/or complexity of data

The amount and complexity of data to be reviewed is based on the types of diagnostic testing ordered or reviewed. A decision to obtain and review old medical records and/or obtain history from sources other than the patient increases the amount and complexity.

Amt and/or complexity of data

Discussion of contradictory or unexpected test results with the physician who performed or interpreted the test is an indication of the complexity of data being reviewed. On occasion, the physician who ordered a test may personally review the image, tracing or specimen to supplement information from the physician who prepared the test report or interpretation.

Risk of Significant Complications, Morbidity and/or

Mortality These are based on the risks associated with the

presenting problem(s), the diagnostic procedure(s), and the possible management options.

The table of risk breaks down different categories.

Levels of risk are determined by the risk of the: Presenting problem(s) Diagnostic procedure(s) ordered Management options selected

How do I build an E/M level?

There are so many complexities and facets I have to address when extracting data from a chart. Where do I even begin!?

Calculating an E/M Level

When calculating the history portion, all three elements in a row must be met (HPI, ROS and PFSH). You must have 3/3 for a given category in the table, or you must drop to the lowest level.

Level

1-3 HPI

0 ROS 0 PFSH

PF

1-3 HPI

1 ROS 0 PFSH

SPF

4+ HPI 2-9 ROS

1 PFSH

D

4+ HPI 10+ ROS

2/3 PFSH

C


When calculating the exam portion, choose the exam that matches how many levels were met.

LEVEL

1 Area/System PF

2-7 Systems EPF

2-7 Systems or 3+ each system

D

8+ Systems C


Number of diagnoses or management

options

Amount and/or

complexity of data to be reviewed

Risk of complications

and/or morbidity or

mortality

Type of decision making

Minimal Minimal or none

Minimal Straightforward

Limited Limited Low Low

Multiple Moderate Moderate Moderate

Extensive Extensive High High


Self-limited or minor (stable, improved, or worsened)

Max 2 points

1 point

Established problem (to examining MD); stable or improved 1 point

Established problem (to examining MD); worsening 2 points

New problem (to examining MD); no additional workup planned

Max 3 points

3 points

New problem (to examining MD); additional workup (eg, admit/transfer)

4 points

Amt and/or Complexity of Data Reviewed

Lab ordered and/or reviewed 1 pointX-ray ordered and/or reviewed 1 pointMedicine section (90701-99199) ordered and/or reviewed 1 point

Discussion of test results w/ performing physician 1 point

Decision to obtain old records and/or obtain hx from someone other than the pt

1 point

Review and summary of old records and/or obtaining history from someone other than patient and/or discussion with another health provider

2 points

Independent visualization of image, tracing or specimen (not simply review of report)

2 points

Table of Risk

See attached table of risk (separate)

Choose the highest risk out of each of the categories.

Because your MDM needs 2/3 elements to be satisfied, you can choose the highest risk and be sure to tally the points so that your level can be justified. However, due to the other two grids, the level may be lowered.

E & M Clinical Examples

E/M Coding ExampleHISTORY -- DETAILED

HPI:Location (bronchial asthma)Timing (one day per week)Context (exercize induced)Modifying factors (treated with Albuterol Inhaler)

ROS:Respiratory (snoring & sleep apnea)Psych (depression)GI (GERD symptoms)

PFSH:Past (history of aspirin intolerance)Social (no environmental changes)

EXAM – EXP. PROB. FOCUSEDConstitutional (general condition/VS)Eyes (conjunctivae)ENT (TM/nasal mucosa)Respiratory (lungs)Cardio (CVS)

MDM -- MODERATE4 DiagnosesPrescription Drug Mgmt

BILLED AS: 99213

SUPPORTS: 99214

REQUIRED FOR NEXT LEVEL:“All other systems reviewed & negative”3 other body systems in Exam

HISTORY – EXP. PROB. FOCUSED

HPI:Location (arms, legs & neck)Associated signs & symptoms (not puritic nor

painful)

ROS:Constitutional (no fevers)All/Immuno (allergies reviewed and updated)

PFSH:

Past (immunization history, unremarkable)

EXAM – EXP. PROB. FOCUSEDConstitutional (VS)Eyes (conjunctivae)ENT (TM/no erythema)Respiratory (without rhonchi, wheezes)Cardio (RRR, no murmurs)GI (soft, NT/ND)Skin (large vesicular-bullous lesions)

MDM -- LOW1 new problem – no additional work-upObtaining history from someone other than ptOTC drugs

BILLED AS: 99213

SUPPORTS: 99213

REQUIRED FOR NEXT LEVEL:2 elements HPI8 ROS or “all others reviewed…”1 additional body system in exam

Clinical example:

1.An established patient is seen in the clinic for

allergic rhinitis. A problem focused history, EPF exam and a low level of MDM were performed. What E/M code would be reported for the visit?

a. 99212b. 99213c. 99214d. 99215

Clinical example answer:

1.b. 99213Established patient requires 2/3 key

components.

Clinical example:

2.A patient is admitted to the hospital for a lung

transplant. The admitting physician performs a comprehensive history, a comprehensive exam, and a high level of MDM. What CPT code should be reported?

a. 99221b. 99222c. 99223d. 99234


2.c. 99223Initial hospital care codes require 3/3 key

components to be met.

Clinical example:

3.A new patient is seen in the pediatric office for ear pain. The

patient has had pain for four days and it keeps her awake at night. She has had a slight fever (99 degrees). She has not been swimming or actively in water for the past couple of months. She denies any cough, nasal congestion, or stuffiness, or loss of weight. The provider does a limited exam on the ears, nose, throat and neck. The patient is determined to have otitis media. Amoxicillin is prescribed. What E/M code would be reported for this visit?

a. 99201b. 99202c. 99203d. 99204


3.b. 99202For a new patient visit, all three key

components must be met. This visit has an EPF HPI, EPF exam and moderate MDM for prescription drug management.

Clinical example: 4.

A 45-year old patient is seeing the neurologist, Dr. Williams, at the request of his family physician to evaluate complaints of weakness, numbness, and pain in his left hand and arm. The pain started last year after rocks fell on him while mining. He still has significant, sharp, burning wrist pain and reports the problems are continuing to get worse. He is limited in his job as a machinist for a mining company due to the pain and numbness. He has no swelling in his hand, no neck pain, or radiating pain.

His past medical history is negative for significant diseases. He has had carpal tunnel surgery. He has a family history of hypertension, heart disease, and stroke. He is married with children and smokes one pack of cigarettes/day.

Clinical example (cont.)

A detailed exam is performed of the mental status, cranial nerves, motor nerves, DTRs, sensory nerves, and head and neck.

After performing an EMG and NCS, Dr. Williams determined the patient has left ulnar neuropathy, at the cubital tunnel region, as well as ongoing carpal tunnel syndrome. Repeat carpal tunnel surgery is recommended, along with a possible cubital tunnel surgical procedure. If the patient does not have surgery, he risks permanent nerve damage. A report is sent back to the physician requesting the consult. What E/M consultation code would be reported for this visit?

a. 99242b. 99243c. 99244d. 99245


4.b. 99243A consultation requires all three key

components be met to support the level of visit.

There is a detailed history, detailed exam and a moderate MDM for the elective major surgery.

Contributory Components

Counseling Coordination of Care Nature of Presenting Problems, and Time

Contributory Component: Counseling

May be included during the visit of a patient and reflect conversations with the patient and/or family regarding risk reduction, treatment options, benefits and risks associated with differing treatment options and other education given to the patient/family.

Often occurs when there is a complicated illness/injury or when there is a newly diagnosed patient with an acute or chronic illness posing a threat to life.

Counseling example:

“I had an extremely extensive 60+ minute examination and series of discussions with the patient and her family members. Over half of the time was spent on counseling them. At great length, with the patient and her daughter, and later with her son-in-law who arrived secondarily, and later again with her husband, who arrived at the end of my visit, I discussed how diabetic injury, especially with neuropathy, she would be at risk, over time, of valvular dysfunction in the leg veins. I discussed the anatomy and physiology of orthostatic hypotension, and how this can be very pronounced, especially in long-term diabetics…”

Contributory component: Coordination of care

Usually with other providers or agencies Without a patient encounter on that day Reported with case management codes Example:

Physician spends 20 minutes assessing a patient with recurrent ear infections.Spends additional 20 minutes counseling parents with strategies to decrease the incidence of ear infections, treatment options and allaying parent anxiety.

99213 E/M selected on the basis of time criteria (more than 50% of face-to-face encounter dominated by counseling).

Contributory component: Nature of presenting problem(s)

Reason for visit: sign, symptom, illness, or disease being treated

Minimal- may not require presence of physician, services are provided under physician’s supervision.

Examples: removal of sutures, supervised drug screen, patient needs release for school/work.

Contributory component: Nature (cont.)

Self-limited or minor-

Does not permanently alter health status and with management and compliance has an outcome of “good”.

Typically heal well on their own without physician supervision.

Examples: poison ivy, poison oak exposure, sore throat, resolved tonsillitis

Contributory Component: Nature (cont.)

Low-

Risk of morbidity/mortality without treatment is low and full recovery with no functional impairment is expected.

Examples: management of a hypertensive patient on medication, established patient for follow up of osteoporosis, painful bunion.


Moderate-Risk of morbidity/mortality without treatment is moderate, uncertain prognosis or increased probability of prolonged functional impairment.Examples: diabetic w/ complications, s/p MI patient who is not doing well on medication, patient with new onset of RLQ abdominal pain


High-

Risk of morbidity/mortality without treatment is highly probable; uncertain prognosis or high probability of severe prolonged functional impairment.

Examples: s/p transplant patient developing new symptoms or cancer patient with signs of paralysis

Contributory Component: Time

“When counseling and/or coordination of care dominates (more than 50%) the physician/patient and/or family encounter…” (CPT guidelines)

May include face-to-face time in the office or other outpatient setting, or floor/unit time in the hospital or nursing facility, and includes time spent with parties who have assumed responsibility for the care of the patient or decision making whether or not they are family members.

Contributory Component: Time (cont.)

Time the physician spends taking the patient’s history or performing an examination does not count as counseling time.

He/She must look at the entire patient encounter and determine if they spent the majority of time in counseling and/or coordination of care or if they should bill using an E/M.

Contributory Component: Time (cont.)

Counseling and coordination of care could include discussion with the patient (or his or her family) about one or more of the following, according to CPT guidelines:

Diagnostic results Impressions and/or recommended diagnostic studies Prognosis Risks and benefits of treatment options Instructions for treatment and/or follow-up Importance of compliance with chosen treatment options Risk-factor reduction Patient/family education

References:

E/M University, http://emuniversity.com Current Procedural Terminology (2011). (2011). Chicago : American

Medical Association Buck, C. (2010) Step-by-Step Medical Coding. Retrieved May 28, 2011.

www.educode.com/vaees (private access) 2011 Medical Coding Training (2011). Salt Lake City: American Medical

Association Department of Health and Human Services. Evaluation and Management

Services Guide. , 2010. Web. 28 Jun 2011. <https://www.cms.gov/MLNProducts/downloads/eval_mgmt_serv_guide-ICN006764.pdf>.

Pierce, B. (2008) Advanced Coding Education Guide for Evaluation and Management Auditing.Rockville: DecisionHealth.

THANK YOU!

I appreciate your time in joining us today to refresh your understanding of the E/M process.

So many of you have been doing this for years and I understand and appreciate the talent you have in determining levels.

Let’s continue to stay on task and use the proper rules for coding these visits, so that we can maintain accuracy and compliance within the health care system.

-Grace Bower, CPC Outpatient Coding/Billing Liaison

NOTES:

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Evaluation_and_Management[1]

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