I'm gonna start with the E/M calculators. We created these quick tools to be able to utilize to apply the new E/M guidelines. We have a calculator for twenty twenty one that is for office and other outpatient services. And then we have the E/M calculator for twenty twenty three that includes all of the E/M categories based on the changes that were published in the twenty twenty three CPT^® code book.

What we have here is the tool. So I'm gonna go into twenty twenty one first, and you'll notice that it's very easy to navigate. So we're gonna walk through a scenario together to see how you would utilize this tool. So first of all, I wanna indicate my type of service.

So for this particular case, I'm going to do office and other outpatient services. Now I'm going to drill down to say if it's new or established. So let's say we have an established patient that came in and they came in today.

I'm gonna save that information. Now it's automatically going to take me through medical decision making. If I wanna code it based on time based instead, then I would just click on the time based little tool here. But I'm gonna go through the medical decision making process.

With MDM, we are selecting the code based on three elements: the type or complexity of the problem that's being addressed at that visit, the data that's involved that the provider has to evaluate, as well as the risk for management of the patient.

So let's say that I have a patient come in and they have hypertension that's stable and they have diabetes that is not at management goal. So patient reports that while they're at home, their blood sugar levels have been higher than normal. They're adhering to their oral medication, but they've just noticed that diabetes is not well managed.

When I go through and categorize this type of presenting problem, I had hypertension that was stable, so I have a stable chronic illness.

I also have a chronic illness that is not at treatment goal. So that would be considered exacerbation, but there's no indication that it's severe, okay? So it's not being well maintained, it's going to be addressed at this visit.

So I would mark off for the hypertension as well as the diabetes.

Now, when the patient comes in, let's say that the physician is reviewing their labs from the last visit. Let's say for this particular patient with these types of issues, they're doing a CBC and a comprehensive metabolic panel and a glucose test, the H1AC.

Now we will count that as three unique tests that are either being reviewed or ordered. Okay, so let's say that they ordered and reviewed at the same date of service and I get the results back on the same day.

Applying the EM guidelines, that would be considered a review if you're doing it both on the same date of service. So when we are counting for data within the medical decision making, the same test that was ordered, we're getting credit for the order and review of the same test. So we're not double dipping.

If something is ordered, it's expected that it is going to be reviewed. So we're getting credit for that at the time of the order. So for offices that have the ability to run the test same day where the physician gets the results immediately, that makes total sense. But let's say that I'm seen today and this particular patient, they order the test and they're not going to come in for a few days.

When you're calculating the E and M, you're counting it at the time of the order because those tests are going to come in a few days from now when the patient's no longer in the office.

So we're getting credit for the work that's anticipated because if you're going to order a test, you're going to review a test. So you're only getting credit at the time of the order unless the order is happening at a non face to face encounter. So let's say that they order the comprehensive metabolic panel, something comes back abnormal, the physician orders additional testing, the patient is called and told about the additional test. When the patient comes back into the office for the review of that test, it could then be counted because that order wasn't given credit during a face to face encounter that affected the E/M level.

So in my particular example that I'm walking you through, we are going to do a review of those three unique tests that I just spoke about.

Now, when it comes to what they're going to be doing in order to treat the patients, okay, we are gonna look at most likely the physician may alter the medication that the patient is taking or order an additional medication.

So for diabetes not at management goals, more likely there's going to be prescription drug management that's being performed.

So I'm gonna click on that. So I've got stable hypertension, diabetes that's not at treatment goal. I have three unique tests that were reviewed.

I have prescription drug management, which is moderate risk. Okay. When I have all of those three elements of MDM together, it levels me out for an established patient to be a ninety nine thousand two hundred fourteen.

Okay? So this is how I would utilize this tool. So if you're getting used to the new guidelines or you need help determining what the correct level is, you can use this free tool on our website to help you with your code selection.