# E/M coding help - Central Billing



## burnam (Mar 17, 2011)

I was just wondering if anyone had anything that may could help us with E/M coding. That is the hardest part of coding for me. We have a group of 14 practitioners, different specialties who are in 9 different locations. We have a Central Billing Office apart from any of the offices, where we house our billing/coding staff, cashier, etc.  We are disagreeing with some of the E/M codes that our physicians select for their hospital visits. (not all of our physicians code their own hospital E/M visits)  We have always just used the code that we see fit, but now we are having a physician get upset because we are changing the code. We need assistance in coming up with a way to communicate these differences with the physicians as in the past we have come from a one specialty private practice where it didn't matter. I am not fully comfortable with E/M coding, but go by the training that I have had from my previous supervisor (who is no longer here) and could use some help in this area. I have done webinars, read the guidelines and several E/M coding books, but still cannot get it to click. Please help!!! Thank you in advance.


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## Pam Brooks (Mar 17, 2011)

I'd be happy to help you with this....but it's a lot of information for an email.  I sent you a PM with my contact information.  Pam


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## rollinholy (Apr 16, 2012)

*E/M coding*

in need of a template, download, or some reliable source that I could use daily to get E/M to click and explain methods to my docs 
(gen. surg. progr. notes)


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## FTessaBartels (Apr 20, 2012)

*E/M University*



rollinholy said:


> in need of a template, download, or some reliable source that I could use daily to get E/M to click and explain methods to my docs
> (gen. surg. progr. notes)



The best source of information for explaining to doctors is www.emuniversity.com
Some of the information there is free; but more detailed information is available for a subscription,webinar fee or conference fee.

The one thing I have found most helpful in communicating with the physicians is impressing upon them the need to document their medical decision making.  Is this is new problem? Are additional diagnostic studies needed (or have already been ordered/performed) - CT, US, labs? What are the differential diagnoses?  What is the treatment plan?  Did you have to spend 20 minutes or your 30 minute visit in counseling/coordination of care?

I then help them with history - the medical necesity of knowing what brings the patient to you (HPI - where is it, how bad is it, how long, have you tried anything and did it help, any associated symptoms).  The medical necessity of an ROS - any other bowel problems? fevers? rashes? allergies? headache or other pain? The medical necessity of a PFSH - medical/surgical history is easy to sell - social history includes alcohol/tobacco use; school or daycare for children -  family hx of disease or difficulty with bleeding or anesthesia (especially important for surgery on children who don't have a personal surgical history yet)

Finally, they should document as comprehensive an exam as they feel is medically necessary given the presenting problem.  If the patient comes in with a splinter in a finger, I'm not expecting them to listen to their lungs or examine the abdomen for tenderness. If the patient comes in with a 4-day history of headaches, fever, chills and vague belly pain, I would expect a more thorough exam as the MD tries to figure out what is wrong. 

Hope that helps.

F Tessa Bartels, CPC, CEMC


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