Toughest E/M issues


Stuart, Florida
Best answers
Hey everyone!!

As coders, students, and seasoned coders alike what do you find to be the hardest or toughest issue you face when it comes to coding E/Ms? My issue has always been coding the hospital visits for the physician on the same day that a procedure was done. Was it separate and distinct or was it a decision for surgery or was it just pre-op??

And go!


True Blue
Salt Lake City, UT
Best answers
For your situation my guess would be that the docs are performing pre-op visits. Physicians don't normally see patient's at a hospital unless they are already admitted and it usually takes a day or two to get them on the surgical schedule. Unless the patient is already admitted, I think your mostly seeing pre-op visits. The hardest thing for coders to grasp, E/M wise, is that they can't code a visit (performed in a hospital setting) until the patient is released and you know the final status of the patient. A physician can see someone in the ER, but if that patient gets admitted, that turns into an inpatient visit. Consultations are misunderstood by physicians and coders alike. You will rarely see an actual "consultation". In the office or the hospital. If a patient is in the hospital and will have surgery, they have physicians of all the various specialties see the patient before surgery. Physicians think these are consultations, but they are not. Or if a physician sends the patient to another provider, this is not a consolation either. Medicare and about half of private insurance won't pay for consultations any longer, so get them off your radar coders! There are too many E/M coding challenges to go into here. I have coded various specialties both inpatient and out.