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Thread: Need help with E/M

  1. #11
    Join Date
    Apr 2007
    Lubbock, TX


    AAPC: Back to School
    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
    Join Date
    Apr 2007
    Carmel, 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.


    2016 Secretary
    Ellenville, NY Local Chapter

  3. #13

    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. #14


    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
    Join Date
    Apr 2007
    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. #16


    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

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