Page 2 of 2 FirstFirst 12
Results 11 to 16 of 16

Need help with E/M

  1. #11
    Medical Coding Books
    Quote Originally Posted by MnTwins29 View Post
    but for many visits, doesn't the nature of the presenting problem or the diagnosis take care of medical necessity by bumping down the MDM level, thereby lowering the overall code assigned? Brandi's statement of not assigning a 99215 to a cold is absolutely correct. But unless the doctor is documenting the patient's history since 1927, and examining every part of her body, how would you get 99215? How would this diagnosis possibly even get close to a high level of MDM? You couldn't get 4 points on nature of the presenting problem, it can't be a high level of risk, and could you really get 4 data points? Realistically, I don't see how it would happen, even if you copy and pasted every visit the patient ever did.

    I understand Brandi's point, and I concurr with the meaning of the statement, but I just can't see it in the real world. Now, if you say that these kinds of actions can result in overuse of 99214 with colds, then I say that is a stronger possibility and more of a problem that can arise.
    That example was meant as hyperbole, rather than realistic -I was aiming to illustrate the point that medical necessity has to be taken into consideration, when selecting the E/M level... but I have seen real examples that are comparable (with enough documentation to satisfy the technical requirements of 99214/99215, for conditions like sinusitis). It's pretty easy to over-document with EMR prompts doing most of it for them.

  2. #12
    Ellenville, New York
    Default Hyperbole....thanks!
    Sometimes in these forums, or in e-mails, it can be hard to separate hyperbole from "real world", humor from anger and the like. I don't discount the medical necessity angle - I have just found in my chart reviews I have more troubles with colds, pharyngitis, epitaxis, etc being assigned 99214 because of overdocumentation in the History and Exam instead of these resulting in 99215. And, IMO, this many 99214s is more problematic than assigning a 99215 to one visit for any one of these problems, because the former happens MUCH more frequently.


    Director, Health Information Management
    HealthAlliance of the Hudson Valley
    Kingston, NY

    2016 Secretary
    Ellenville, NY Local Chapter

  3. Default Terrible at E/M
    I have the exact same problem. Passed the course, passed the exam. Don't understand a single concept of E/M

  4. Default
    txkimberco and hydster: I would be happy to share my E/M worksheet with you. It literally walks you through the E/M coding process step by step.

    Just click on my profile and choose the tab that says "contact info."

  5. #15
    Quincy, MA
    I have this problem too passed my class passed the exam now working on practicode and I can't get a single E/M question correct because in my class it was spelled out for you this is a detailed history detailed exam and MDM is moderate

  6. Default
    I fully agree with Brandi's statement about "overdocumenting" thanks to EHR clickies.

    There is just no way I'm even considering coding a 4 without either a new chronic problem, two worsening chronic problems, or three chronics that have had their status checked clearly in the note - I don't care how good the HPI or exam is - and THEN I check for labs ordered, meds adjusted, etc., THEN I'll go back and see if the history and/or exam supports a 4.

    My clinic director is on me all the time to push more 4's through, but I can't make chicken salad out of chicken spit. Sometimes, a cold is just a cold

    I really wish someone would just nuke the 95 and 97 guidelines and rewrite them from scratch. I guess I wouldn't make a very good CEMC

Page 2 of 2 FirstFirst 12

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts
Enjoying Our Forums?

AAPC forums are a benefit of membership. Joining AAPC grants you unlimited access, allowing you to post questions and participate with our community of over 150,000 professionals.

Join Now Continue Reading Without Full Access

Already a Member?


Close Message

In addition to full participation on AAPC forums, as a member you will be able to:

  • Access to the largest healthcare job database in the world.
  • Join over 150,000 members of the healthcare network in the world.
  • Be a part of an industry leading organization that drives the business side of healthcare.
  • Save anywhere from 10%-50% with exclusive member discounts on courses, books, study materials, and conferences.
  • Access to discounts at hundreds of restaurants, travel destinations, retail stores, and service providers. AAPC members also have opportunities to save on heath, life, and liability insurance.
  • Become a member of a local chapter and attend regular meetings.