# E/M



## precerts2008 (Mar 2, 2009)

Good Afternoon
i am very new to coding but i am very intrested in e/m coding i don't quite understand the MDM is there a website for dummys for e/m coding?

thanks


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## RebeccaWoodward* (Mar 2, 2009)

I always suggest this site.  There is an abundance of free information.  

http://www.emuniversity.com/index.html


Also.......

http://www.cms.hhs.gov/MLNEdWebGuide/25_EMDOC.asp


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## precerts2008 (Mar 3, 2009)

*e/m coding*

thanks so much i will give those a try


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## PEGGYBRYANT (Mar 4, 2009)

One of the problems I am having, and there was actually just an example on the EM University this week, if a provider documents a level 4 for otitis media but looking at medical necessity it looks more like a 3 what do you do?  I can see it both ways.  With the example from EM University that I am referencing I would have coded a 99213.  I definately feel the provider should be the determining factor on this but some of the providers appear to add some fluff to their documentation which could bump it up a level.  Any advice?


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## FTessaBartels (Mar 5, 2009)

*E/M university otitis media example*

Peggy,
I'm with you ... I would have coded a 99213 based on medical necessity. But the note DID qualify for 99214, so if I were auditing it, and the physician had marked 99214, I'd have to agree that the documentation met that standard. 

Clear as mud, ain't it?

F Tessa Bartels, CPC, CEMC


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## milant (Mar 5, 2009)

I have a quick question on E/M's if you all woundn't mind taking a minute to think abou tit for me. On the table of risk it states at the top Presenting Problem. We have bgeen going back and forth on this and if any of you know where I might be able to find something in writting on this it wouls be a tremendous help. Some think that the "Presenting Problem" on the table of risk means the cheif complaint, the reason the patient came in. Some think that it really means the final diagnosis. What are your opnions? I found in Step by Step Medical Coding by Carol J Buck where it states "the presenting problem is the patient's cheif complaint" but in the guidlines it really doesn't state either way. Please help.


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## FTessaBartels (Mar 5, 2009)

*Presenting Problem*

Milant writes: Some think that the "Presenting Problem" on the table of risk means the cheif complaint, the reason the patient came in. Some think that it really means the final diagnosis. What are your opnions?

When I audit a note, I define the Presenting Problem on the table of risk by what the physician finds.

Think of it this way:  A patient comes in with a complaint of back pain. But on exam the physician determines this is an MI.  If I just looked at the chief complaint I'd probably give this a minimal or low rating. But if I considered the physician's ultimate Dx I'd bump this up to high.

Also, how would you account for the "stable" "Improving" etc if you only looked at the patient's chief complaint?  These are judgments typically made by the physician.

Hope that helps.

F Tessa Bartels, CPC, CEMC


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