EM Coding Alert

Common sense: Adapt your educational content to your audience.

Teaching providers about evaluation and management (E/M) leveling and service coding can be overwhelming. Luckily, some simple preparations will help make your meeting seamless and allow you to focus on the content.

Try these surefire suggestions shared by Shea Lunt, CPC, CPMA, RHIA, and Emily Lomaquahu, CPC, CPMA, CEDC, during their AAPC HEALTHCON 2025 presentation “Enhancing Provider Education.”

Use These Tips for the Actual Meeting

When meeting with providers, be sure to use pertinent examples. “Make it as specific to the provider as you can. Sometimes, you don’t have their actual notes, so you have to go with what you have; but try to make the notes look as real as possible, feel as real as possible, and be applicable to that provider and the work that they’re doing,” Lunt suggested.

Also, have an agenda in mind. You don’t need to show it in your slide deck, Lunt said, but have it in mind and have a plan about what you’re going to say. A sample agenda might be an introduction of oneself, some background information on the provider — Are they new to coding? Do they have inpatients or outpatients? — and then an overview of what you’ll cover in the session. This might include an overview of E/M, and then deeper dives into medical decision making (MDM) and time, before covering some other coding information like modifiers and diagnosis codes, along with leaving time for questions.

Remember to prepare handouts. “We get asked for handouts like 95 percent of the time, so be ready to go. Have that PDF ready to send. Maybe just send it ahead of your meeting time! We often do that, so they have the slide deck, and they can use it for reference later,” Lunt said.

If you’re conducting the meeting virtually, be aware of the most basic technical difficulties and try to accommodate your audience. For example, if they’re used to using one virtual meeting platform, try to conduct your meeting accordingly so they can access it confidently on their computer or device.

Knowing the electronic health record (EHR) platform of choice for the office — and how providers might access support in navigating it — is also helpful. Lunt explained that providers often have questions like “How do I build a template?” or “How do I file my charge?”; and either being able to answer those questions, or having someone on hand who can direct providers to an answer, is extremely helpful.

Consider Timing of New Provider Education

Incorporating E/M leveling education as part of the onboarding process can be effective, Lomaquahu said. “We tend to schedule one-on-one sessions with providers as part of their onboarding schedule and make it web-based to make it easier to schedule and easier to attend.”

Such one-on-one sessions can allow for a freer, more flowing conversation, she said. “It’s an opportunity to build that relationship and get that started on the right foot right away.” The onboarding process may be crowded with other must-know information about the practice or workflow, but finding a way to accommodate coding education can be helpful.

If you do manage to schedule a one-on-one session early on with a new provider, you can circle back a few months later to make sure the concepts are clicking. “One to three months later, we’ll do a 10-chart review. If the accuracy is 90 percent or higher, no additional meeting is going to be required,” Lomaquahu said. Of course, you should make sure the provider is performing to your practice’s standards, whatever the policy on coding accuracy.

“Sometimes the provider does request [a follow-up meeting], and that’s not a bad thing — it’s a good thing. It means that you’ve built that relationship with them right off the bat, and now they’re comfortable coming to you, asking questions … if they do that, and the results are not the goal, we’ll schedule a review session to target those specific problem areas that were identified on that review,” Lomaquahu explained.

Rely on These Tips

Think of provider education as a means of building a relationship — and show sensitivity and thoughtfulness about the provider’s time. They suggest scheduling an hourlong meeting but planning to present content for only 45 minutes. Even though E/M content takes a long time to really go over, a shorter session can keep attendees’ attention and minimize grumbling. You can use any extra time for freeflow conversation, and if it doesn’t happen, you can end the meeting early.

Be aware of your tone, too. “We try to keep it casual and friendly … the way I enter into these kinds of things is, I say, ‘This is your time to ask what you need to ask, and I’m happy to have those conversations with you,’” Lomaquahu said.

Also, avoid the “A word.” “We do stay away from the word ‘audit.’ Nobody likes to be audited. It sounds too official, and it sounds like you’re going to get punished at the end, and we don’t want people feeling like that’s the case. So we’ll use the term ‘review.’” Lomaquahu said that “review” is less formal and better communicates that meeting is more of a check-in to identify any problems as early as possible and correct them without consequences.

Rachel Dorrell, MA, MS, CPC-A, CPPM, Development Editor, AAPC