E/M Coding

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E/M coding is not my strong suit. Is there anybody out there that can help ? any suggestions? I am stuck on chapter 19 E/M Services....Help! :)
 

Jennifer Turner

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What is it in particular that you are needing help on? When you mention chapter 19 are you referring to the material in the CPC Course?
 
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Yes in the CPC Coding course. In my practical application workbook. I'm reading the questions but I'm not exactly sure what level of coding these questions are . I have read the chapter but I'm still confused . I know some of these components need 2 of 3 or 3 of 3 for the type of coding. I'm kind of lost on what I'm looking at when I'm looking at this. I need some help on this, please. Any suggestions. Thanks.
 

kslynn

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E&M coding

E&M coding is something that takes a while to get used to and practice makes perfect. I have been coding E&M for several years and love it. The most helpful tool I have found for coding these is an E&M Audit form.

https://www.uth.edu/dotAsset/8dfbfc4f-a1fb-4d00-8b96-2919e3012795.pdf

This form will take you step by step through the process and covers both the 1995 and 1997 rules. I prefer filling them out using the 1995 rules. They are much easier to use. This audit form breaks the process down into the three components needed to assign the correct code (History, Exam, and Medical Decision Making). It further breaks each component down into understandable portions. You also need to know the terminology of some portions of the form especially the History of Present Illness (HPI). Terms such as quality, duration, timing, context, modifying factors, etc. can be a little confusing. Read the requirements for each section for new and established patients.

CMS has a booklet that explains this process. https://www.cms.gov/Outreach-and-Ed.../Downloads/eval-mgmt-serv-guide-ICN006764.pdf

I hope this helps

Kathy Lynn, RHIT, CPC-I, CPC, ASB
 

Jennifer Turner

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In a briefing something to keep in mind is that your New patient visits OR Initial Visit will always require 3 of 3 components & your Established patient visits OR Subsequent visits will always require 2 of 3 components. As mentioned E/M is one of those areas that require a lot of practice before you can become comfortable in coding it. Practice does make perfect!

Kathy provided very helpful references. Also if it's in your budget E/M university have a very basic E/M course for $19.95... It covers pretty much everything that you will need to know as far as the 3 main components go (History, Exam, MDM).
 
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