Evaluation and Management: E/M Medical Decision Making

Outline:

Section 1: Introduction

About This Course

Learning Objectives

Section 2: Overview

E/M Overview

Evaluation and Management Services

Medical Decision Making

Types of Medical Decision Making

Review

Summary

Section 3: Medical Decision Making Guidelines and Definitions

MDM Element: Number and Complexity of Problems Addressed

Minimal problem

Self-limited or minor problem

Stable, chronic illness

Acute, uncomplicated illness or injury

Acute, uncomplicated illness or injury requiring hospital inpatient or observation level care

Stable, acute illness

Chronic illness with exacerbation, progression, or side effects of treatment

Undiagnosed new problem with uncertain prognosis

Acute illness with systemic symptoms

Acute, complicated injury

Chronic illness with severe exacerbation, progression, or side effects of treatment

Acute or chronic illness or injury that poses a threat to life or bodily function

Documenting Problems and Management Options

Examples

Important Note

MDM Element: Amount and Complexity of Data to Be Reviewed and Analyzed

Analyzed

Test

Unique

Combination of Data Elements

External

External physician or other qualified health care professional

Discussion

Independent historian

Independent interpretation

Appropriate source

Documenting Data Review

Examples

MDM Element: Risk of Complications and/or Morbidity or Mortality of Patient Management

Morbidity

Social determinants of health

Surgery

Drug therapy requiring intensive monitoring for toxicity

Parenteral Controlled Substances

Documenting Risk

Examples

Important Note

Levels of MDM Criteria

Review

Summary

Section 4: Determining the Level of MDM

Determine the Extent of MDM

E/M Example 1:

E/M Example 2:

E/M Example 3:

E/M Example 4:

Coding Application: Selecting the Level of MDM

Clinical Scenario 1

Clinical Scenario 2

Clinical Scenario 3

Clinical Scenario 4

Clinical Scenario 5

Summary

Section 5: Conclusion

Course Summary

Course Information

Course Contributors

Resources

References

Sarah is a Subject Matter Expert/Writer for Relias's Revenue Cycle and Coding online education. Sarah is credentialed by AHIMA as a Certified Coding Specialist (CCS) and Certified Coding Specialist Physician-based (CCS-P), as well as an approved ICD-10-CM/PCS Trainer. She is also credentialed by AAPC as a Certified Professional Coding Instructor (CPC-I), a certified professional coder (CPC), a certified outpatient hospital coder (COC), and a Certified Risk Adjustment Coder (CRC), with specialty certification in Evaluation and Management Services (CEMC). Sarah extensive experience in both professional and facility ICD-10-CM/PCS, CPT, and HCPCS coding, education, auditing, and revenue cycle management. She has clinical experience as an Emergency Medical Technician (EMT) and Medical Assistant (MA) and has served as Director of Physician Billing and Reimbursement for a regional health system, Manager of Coding and Compliance for a hospital and cancer center, and Business Manager of Physician Practices at a teaching hospital, as well as a coding auditor and consultant. Sarah has also authored several coding textbooks, and other instructional resources.

Ronntriesse Cope-Prevatt, CPC, CRC
Ronnie is a certified coder with over ten years of experience in profee coding, billing, and auditing. She also has a strong background in HCCs, patient administration, working claims edits, and denials management. Ronnie's coding expertise is in the areas of Orthopedics, Neurology, Pain Management, Interventional Cardiology, Gynecology, Urology, General Surgery, Gastroenterology, and Primary Care.