E/M Coding – Seldom Used But Helpful Knowledge

The following pages will detail a series of evaluation and management coding features that are underutilized by providers and that can result in tens of thousand of dollars of lost revenue per year, per provider.   This occurs primarily due to a lack of physician/provider expertise in using E/M coding guidelines rules,  lack of features within the automated coding tools with a high percentage of EHRs that would allow them to recognize and use this information to suggest the correct E/M code, and variations between payers regarding their documentation and coding guidelines.

The following are discussed via the links below:

  1. HPI: Three or more chronic conditions and their statuses
  2. HPI: Definitions of how to use the 8 HPI elements
  3. PFSH: Medication lists qualify as past medical history
  4. PFSH: Problem lists qualify as past medical history
  5. ROS: Number of items needed to reach an “extended” level of service
  6. ROS: Information captured in the HPI qualifies for the relevant ROS and PFSH component(s)
  7. PE:  Specialists and primary care should use the 1997 Organ System examinations
  8. PE: When using the 1995 guidelines might be to your advantage
  9. Novitas “4 by 4” physical exam rules for the 1995 Guidelines
  10. Complexity: How to use the number of diagnoses/management options
  11. Complexity: How to use the amount/complexity of information
  12. Complexity: How to use risk

The information contained within this article and links, unless otherwise stated, represents the opinions of Michael Stearns, MD, CPC, CFPC

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