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E and M definitions

  1. Default E and M definitions
    Medical Coding Books
    I am a fairly new coder and still learning a great deal with my new employer, and I need some help on E and M codes. I am trying to distinguish between a problem focused physician visit, and a expanded problem focus visit. Can someone provide me with a practical example and explanation on recognizing between these two codes?

    Also, can someone please provide me with a definition between what constitues a limited physical examination and an extended physical examination??

    Thanks from a rookie coder....

  2. #2
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    Quote Originally Posted by rex.helmsing View Post
    I am a fairly new coder and still learning a great deal with my new employer, and I need some help on E and M codes. I am trying to distinguish between a problem focused physician visit, and a expanded problem focus visit. Can someone provide me with a practical example and explanation on recognizing between these two codes?

    Also, can someone please provide me with a definition between what constitues a limited physical examination and an extended physical examination??

    Thanks from a rookie coder....
    Have you had a chance to look at the CMS E/M Documentation guidelines?
    (http://www.cms.gov/MLNEdWebGuide/25_EMDOC.asp)
    There are 2 sets: the 95 and 97 guidelines - both make a pretty big distinction between PF and EPF visit requirements. Read over them, and let me know if you still have trouble understanding the difference. Another place I recommend looking is in the Clinical examples in Appendix C of the CPT book. For instance, if you look at the difference between the types of problems that warrant a 99212, vs. a 99213 (see page 566 of the 201 AMA Professional Edition), you can get an idea of what the biggest differences are. In a nutshell, PF visits are for problems that would get better with medical treatment, but probably would have gone away on their own (eventually), otherwise. EPF visits are a little bit more complex, but not much; they're problems that still aren't life-threatening, but require medical attention more than the PF visit types. (Usually some kind of OTC treatment has failed to show improvement, or they're in to get a refill on medications for conditions like HTN, or other stable chronic conditions.) Hope that helps!

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