1. What is E/M Coding?

Evaluation and Management (E/M) coding is used to represent the type and complexity of patient encounters in healthcare. The code level is determined by three key components: History, Examination, and Medical Decision Making (MDM).

2. How Does the Calculator Work?

The calculator uses the standard E/M coding rules:

Where:

• History Level - Ranges from 1 (Problem Focused) to 4 (Comprehensive)
• Exam Level - Ranges from 1 (Problem Focused) to 4 (Comprehensive)
• MDM Level - Ranges from 1 (Straightforward) to 4 (High Complexity)

Explanation: The final E/M code is determined by the lowest of the three components (History, Exam, MDM).

3. Importance of Accurate E/M Coding

Details: Proper E/M coding ensures appropriate reimbursement and compliance with billing regulations. It also helps in documenting the complexity of patient care.

4. Using the Calculator

Tips: Select the appropriate level for each component based on documentation. The calculator will determine the correct E/M code based on the lowest component level.

5. Frequently Asked Questions (FAQ)

Q1: What's the difference between 99202 and 99212?
A: 99202 is for new patients, 99212 is for established patients. Both represent level 2 visits.

Q2: How is MDM complexity determined?
A: MDM is based on three factors: number of diagnoses/management options, amount/complexity of data reviewed, and risk of complications.

Q3: Can time be used instead of components?
A: For 2021 and later, time can be the sole determinant if more than 50% of the visit was spent on counseling/coordination of care.

Q4: What are common coding mistakes?
A: Upcoding (using higher level than documented) and underdocumenting (not capturing all relevant elements).

Q5: Are there different rules for inpatient vs outpatient?
A: Yes, different code sets apply (e.g., 99221-99223 for initial hospital care).