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E/M Code Calculation:
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Evaluation and Management (E/M) coding is used to represent the type and complexity of patient encounters in healthcare settings. These codes are essential for billing and documentation purposes.
E/M codes are primarily based on two factors:
The calculator combines these factors to recommend the appropriate E/M code.
Details: Proper E/M coding ensures accurate reimbursement and compliance with healthcare regulations. Undercoding can lead to lost revenue, while overcoding may result in audits and penalties.
Tips: Select the appropriate MDM level based on the complexity of the encounter and enter the total time spent. The calculator will recommend the most appropriate E/M code.
Q1: What are the MDM levels?
A: MDM has 4 levels: 1-Straightforward, 2-Low, 3-Moderate, 4-High complexity.
Q2: How is time defined for E/M coding?
A: Time includes face-to-face and non-face-to-time on the date of service for activities like preparing to see the patient, documentation, and care coordination.
Q3: Are there different codes for new vs established patients?
A: Yes, the first digit after 992 indicates new (0) or established (1) patient status.
Q4: What about prolonged services?
A: Prolonged service codes may be used when time exceeds the maximum for the highest level E/M code.
Q5: Are there different rules for inpatient coding?
A: Yes, inpatient E/M codes (99221-99233) have different requirements than outpatient codes.