E&M Medical Coding — How to Level E and M Code (Part 2)


Laureen: How to Level an E&M Code:
Q: Would it be possible to briefly go over your E&M leveling tool? Where I work, the
providers level the visits. I code all diagnosis codes and add the appropriate modifiers.
So I’m really weak on being able to level E&M.
A: I can’t promise the briefly part, but I will definitely share my technique for doing
E&M leveling. Basically, this is a system I teach, this
is actually how I got in doing my “Review Blitz,” I started tutoring people that were
struggling with E&M back in the day. I took my exam in 1999, the E&M questions on the
board were like 25, now they’re 10. So a lot of people were failing the exam just because
of the E&M, so I would do tutoring and then I came up with this system and it really worked
and so many students were like, “I finally get E&M!” So, hopefully, you’ll get that
“aha!” moment tonight. If not, we do have a three hour class on E&M that’s on “On
Demand” and it’s this system that I go over in a little bit slower.
One of the first things that I would teach you to do, if you’re one of my students
is to mark up your E&M section of your CPT manual. I’m a very visual learner, I need
visual cues to help me; so, I did this to help myself.
So, the four possible letters that you would be writing next to your History Bullet is
PEDC and the same for Exam, which stands for Problem Focused, Expanded Problem Focused,
Detailed or Comprehensive. And then, SLMH for the Medical Decision Making, which stands
for Straightforward, Low, Moderate, High. Then, the other notation that you want to
make is whether or not the particular code is a “3 of 3” code or “2 of 3” code.
I’m going to explain all this, so if you’re scratching your head, hang with me here.
My system, what I call it is “Locate your HEM and Time.” It’s the little rhyme that
I teach my students and I actually tell them on their exam booklets or in real world, a
scratch piece of paper, Post-It, or whatever, write this down: Locate ___ (with a line next
to it), H, E, M all with their own line, which stands for History, Exam, and Medical Decision
Making – which are the three key elements of E&M coding and then Time. Sometimes, Time
can be the controlling factor, not the HEM (History, Exam, and Medical Decision Making).
The “locate” of course is the category and sub-category of the E&M: Was it an office
new patient? Was it a hospital ER? That sort of thing.
So when I do these lectures, I spend an hour-plus just going over the categories and sub-categories
because I like to say, “You need to get in the right church and the right pew. You
could be in the right pew but the wrong church.” We have to find the right church first for
the “locate.” Once we’re there and we’ve narrowed it down, for example, to “office”
we know that the location was “office” and now we just need to know is it a new patient
or an established, so then we pick accordingly. Let me show you that. Here’s a blown-up
view of one E&M from my manual, and I just picked 99343. We’ve got three bulleted key
components here. They always are the same for E&M, History will always be the first
bullet, Exam will always be the second bullet, and Medical Decision Making will always be
the third bullet; so the type of E&M code that has bullets, they’ll always be in this
order. Because this particular code was a Detailed
history – I wrote a “D” next to it – the Detailed Exam – so I wrote a “D” next
to it – Moderate Medical Decision Making – I wrote an “M.” You got to be careful
with the Medical Decision Making because the controlling word is toward the end of the
line, so don’t pick “M” for “Medical.” So this one becomes DDM, it’s shorthand.
If you were writing this on your exam booklet or on a Post-It note for a real case, now
you’re going to start seeing these choices. So here it was DDM, so we would have had a
D, a D and an M. Let’s look at them as a group, so we’ve
narrowed it down to we’re dealing with a new patient, so there’s a new office patient.
There are only five choices or what people like to call “levels” and that is why
this is called “leveling.” 99201 – Also known as level one. If you
were to define it using my system, it would be called PPS. Your level two would be an
EES (for expanded problem focused, expanded problem focused, straightforward). Your level
three would be a DDL (detailed, detailed, low). Your level four would be CCM (comprehensive,
comprehensive, moderate). Then your level five would be CCH (comprehensive, comprehensive,
high). So, just looking at the first bullet, you
can start to see the hierarchy. You’ve got PEDC and then C again, so of course E&M coding
can’t be easy and have four codes because there’s four choices for each History, Exam,
and Medical Decision Making. They got to have five levels and that’s not true of all of
the categories and subcategories, but for a lot of them it is.
Now, look at the second bullet. This is for the Exam element. We got problem focused,
expanded problem focused, detailed, comprehensive, comprehensive. It actually follows the pattern
that the History one did. Now, this is what’s it like for a new office patient, but for
another category and subcategory that has five levels, it is sometimes different so you can’t even say a problem focused is always a level one. Oftentimes it’s true, but you
can’t even have a hard-and-fast set of rules for that, so you really have to do them individually.
Then, the last bullet for Medical Decision Making, always “S” for “straightforward”
comes first. Now you’ll notice with this one, the “S” shows up on the level one
and the level two
and then it goes low, moderate, high. So you
need to understand that hierarchy. So PEDC, PEDC, SLMH; and so, when you’re reading
a scenario you’re trying to pull out that information that you can add it on these lines.
On the board exam, quite often, it used to be all of them but I think it’s only 8 out
of
the 10 questions from what I’m hearing from people taking it, where they actually tell
you the physician did an expanded problem focused history. So you’re going to circle
“E” and exam, so you’ve got EE and made moderate medical decision making – so EEM.
You’re going to abstract that information from the scenario. Now, in the real world,
physicians don’t do that; but because E&M is so complicated and the CPC exam is testing
you on a broad-based of knowledge, they normally
will tell you what the history score is or the history level is. They want to see if
you were able to figure out the overall level.

48 thoughts on “E&M Medical Coding — How to Level E and M Code (Part 2)

  1. You have just helped me understand E/M coding!!!!  I never could get it in school or at work.  I am an outpatient ED coder and do not code E/M codes.  In my facility, I code only diagnosis codes and procedure codes.  But I feel much more confident in taking the new COC exam after watching your part I and II Leveling videos and I want to thank you!!!

  2. This is great, Laureen!!  Now I would love to see this done with Hospital E&M coding.  I recently started coding for a Hospital and the E&M for them is difficult for me! Looking at the notes, it's hard to tell what makes up the decision making for E&M coding.

  3. great video! thanks much! I learned my EM level today! I couldn't get it right with my teacher but now I know how to get them! thanks to Ms. Jandroep! God bless you!☺☺☺

  4. Thank you oh so much! I think I am going to purchase your on demand E/M webinar also. I am a CPC-A and am working on getting rid of that A. I am looking forward to what more you help me to understand better. I need more help with surgical procedures and will be looking for help with that. Thanks again!

  5. laureen ..u are awesome…thank you…now i can code the most difficult ones easily….just keep on sharing your knowledge forever

  6. Thank you so much.  I've been struggling in my studies with E/M.  After watching your videos, I can now code EM correctly.

  7. Wow! thank you so much for this video (and part 1). I've been reading my code book and trying to wrap my head around how to choose 3/3 and 2/3. The way you taught it is exactly how my brain works and I got it right away! I wish I could thumbs up this video 1000 times!

  8. This has saved my sanity! Lost much sleep over this. Thank you! Up until now i had not figured this out though I read my CPT guidelines over and over. Why don't all courses explain it this simply? Go figure.

  9. where can i find the E/M on demand webinar that is talked about here….I don't see it on the codingcertification.org website. Thanks.

  10. Oh. My. Gosh. Who would have known how simple this is?! I have stressed so much over it and you have made it incredibly simple.

  11. OMG! This is awesome! I just graduated from a medical billing & coding degree program and I can honestly say that E/M was the hardest part to learn for my class! We struggled with it BAD! Colleges don't teach you how to prepare for the CPC exam, they focus more on the fundamentals of coding… so you really have to invest a little more in outside resources to help polish your skills in time to sit for the exam.

    Watching this, I can now say the light bulb has finally clicked on inside my head. I feel waaay more confident tackling E/M for my CPC exam this summer, thanks to this method. Thank you sooo much for sharing this!

  12. just started studying for the cpc and I am not joking when I say after all the classes I took for my RHIT, I could never make any kind of sense whatsoever of E/M until now. graduated, took the rhit, and never got it until I found CCO when going for my CPC. So thank you very very much.

  13. Oh my goodness thank you so much for that great explanation. Now I understand how to code the E/M leves. I definitely didn't know how to do it at college with my professor and no one else until now that I saw this video. Thank you once again and I'm gonna go and rock the CCs exam soon!!

  14. I wish I found your video sooner!! I am scheduled to take my CPC exam in the next month and was seriously doubting my E/M skills. I'm not worried anymore! I'm going to ace that part! Thank you!

  15. Thank you soo much leveling is soo clear now. I shared this with my teacher n she used your method to teach the leveling. Especially the protocol for 3of3 and 2of 2. I was doing it all wrong I'm taking my second cpc aapc exam in two weeks n I feel ready now. I only failed before by a few points. Wish me luck😊

  16. Which would be the correct E/M code for an office visit by an established patient with these key components EEM? I chose 99213 but I am still in doubt as the levels were 334. Please advise. Thanks much for this valuable video

  17. i understood this in less than 10min. i wish i had found this before my final! TG i discovered it before my exam next week!!! xo thank you for this so much!

  18. Not all providers note tell you about HEM. The main reason for the education is to HEM yourself from the documentation where provider do not specify HEM.

  19. These 2 videos made more sense and were far better taught than the entire chapter in the textbook.  Thank you, thank you!

  20. Do you have videos for specifically leveling history, medical decision making, etc.. In this video you said the specific “bean picking” of leveling those… haven’t a hard time finding any videos that do this!

  21. You are the Guru! I wish I had taken your course because I am using many of your videos and techniques! I take my exam in a few weeks, and when I pass I will definitely be getting further credentials with CCO! 😉

  22. I do have one doubt.. Established patient.. Detailed hx, detailed exam, high mdm.. Which level..?

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