# E/M Quick Reference Helpful or Confusing?



## btadlock1 (Nov 16, 2011)

I made this quick reference for E/M, but I need some objective opinions on its usefulness...I had to save it as 2 different files to make it all fit. Take a look at it, and see if you think it's easy to figure out, or if there's anything you think I should change to make it better...I appreciate the feedback!


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## btadlock1 (Nov 16, 2011)

*Well???*

Any takers? Surely someone has an opinion on it!


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## dja214 (Nov 16, 2011)

It has all the info needed....but it seems a little busy. I'm sure once someone gets used to it they'll be able to fly right through!

Deanna
CPC, CEMC


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## btadlock1 (Nov 16, 2011)

dja214 said:


> It has all the info needed....but it seems a little busy. I'm sure once someone gets used to it they'll be able to fly right through!
> 
> Deanna
> CPC, CEMC



I appreciate it! I did what I could to condense it as much as possible, but with all of the requirements, it was hard to _not_ make it busy...I've got a second version I'm putting together that's a little different, so I'll put it on here tomorrow for comparison. Thanks again!


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## dja214 (Nov 16, 2011)

I'll be more than happy to look at it and let you know what I think.


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## btadlock1 (Nov 16, 2011)

I had these practice questions in mind when I made this - it seems more practical when you're able to use it...

20-day-old infant was seen in the ER by the neonatologist admitting the baby to NICU for cyanosis and rapid breathing. The neonatologist performed intubation, ventilation management and a complete echocardiogram in the NICU and provided a report for the echocardiography which did indicate congenital heart disease. Select the correct code(s) for the physician service. 

 A. 99468-25, 93303-26
 B. 99471-25, 31500, 94002, 93303
 C. 99460-25, 31500, 94002, 93303
 D. 99291-25, 93303


A patient was admitted yesterday to the hospital for possible gallstones. The following day the physician who admitted the patient performed a detailed history, a detailed exam and a medical decision making of low complexity. The physician tells her the test results have come back positive for gallstones and is recommending having a cholecystectomy. What code should be reported for this evaluation and management service? 

 A. 99253
 B. 99221
 C. 99233
 D. 99234

A patient came in to the ER with wheezing and a rapid heart rate. The ER physician documents a comprehensive history, comprehensive exam and medical decision of moderate complexity. The patient has been given three nebulizer treatments. The ER physician has decided to place him in observation care for the acute asthma exacerbation. The ER physician will continue examining the patient and will order additional treatments until the wheezing subsides. Select the appropriate code(s) for this visit. 

 A. 99284, 99219
 B. 99219
 C. 99284
 D. 99235


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## zanalee (Nov 16, 2011)

How about separating the O/V EM tools and a separate one for ER/ Observation. might be easy to use.


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## kumeena (Nov 17, 2011)

btadlock1 said:


> I had these practice questions in mind when I made this - it seems more practical when you're able to use it...
> 
> 20-day-old infant was seen in the ER by the neonatologist admitting the baby to NICU for cyanosis and rapid breathing. The neonatologist performed intubation, ventilation management and a complete echocardiogram in the NICU and provided a report for the echocardiography which did indicate congenital heart disease. Select the correct code(s) for the physician service.
> 
> ...



Can you post the answers.  

Thank you

P.S I really like the tool and I appreciate your time and effort.


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## cherilynn49@yahoo.com (Nov 17, 2011)

I know this took a lot of effort as I tried to do something similar.  Yours is much better.  I know it looks busy at first glance but the whole E/M is in this and it is very helpful.


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## shatita (Nov 17, 2011)

*E/M tool*

I believe this is a great tool but there is a lot on there. I would try to make multiple sheets. I would divide it out by topic. Like have one sheet for Critical Care and then have one for ER. Also the questions you created look great


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## btadlock1 (Nov 17, 2011)

*Here's the second version...*

Thanks for the input!  I'm working on dividing the first version up for Outpatient versus Inpatient/Facility...Meanwhile, here's an alternate version of just the Problem E/M codes with their requirements...

This chart's not _quite_ as busy, but I think the first one is more user-friendly - 
I wasn't able to include the #'s of minutes associated with each code, or any info on selecting the History, Exam, or MDM. It also lacks the preventive exams and critical care info (which I personally thought was the most useful part of the first version, since it boils nearly all of the guidelines into those little charts)...

Thoughts?


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## btadlock1 (Nov 17, 2011)

*I guess the practice question answers would help...*

The first one is: A. 99468-25, 93303-26
Second: C. 99233
Third: B. 99219


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## btadlock1 (Nov 17, 2011)

*Now THIS is busy!*

I managed to squish my original chart onto one page...lol


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## rthames052006 (Nov 17, 2011)

btadlock1 said:


> Any takers? Surely someone has an opinion on it!



I just took a look at your chart Brandi!  I think it's very detailed, yes it's busy but I do agree with why it is "busy".  I really like how you have the breakdown on page 2 with cpt's that are included in_____.  

I think I just might utilize this chart, if you don't mind, I think personally it will help me with the pediatric e/m's as I don't do too much with ped's but with the detailed info you have on the chart, it makes it easier!

Would you mind if I printed these and handed them out to my chapter members?  I'd be sure to give you the credit due .

Thanks,


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## btadlock1 (Nov 17, 2011)

rthames052006 said:


> I just took a look at your chart Brandi!  I think it's very detailed, yes it's busy but I do agree with why it is "busy".  I really like how you have the breakdown on page 2 with cpt's that are included in_____.
> 
> I think I just might utilize this chart, if you don't mind, I think personally it will help me with the pediatric e/m's as I don't do too much with ped's but with the detailed info you have on the chart, it makes it easier!
> 
> ...



Thanks!  
Please do share! If it helps anybody with learning E/M, then it's a success!

For those who don't have Microsoft Word, I've finally managed to upload it in picture-format. Enjoy!


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## patbaylon (Nov 17, 2011)

Nice but a little busy and could somewhat confusing for someone new to E&M coding. Go to www.donself.com and look at his E&M coding tool. Your same idea but not a busy...Good work though!


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## FTessaBartels (Nov 18, 2011)

*Who is the intended audience?*



btadlock1 said:


> I made this quick reference for E/M, but I need some objective opinions on its usefulness...I had to save it as 2 different files to make it all fit. Take a look at it, and see if you think it's easy to figure out, or if there's anything you think I should change to make it better...I appreciate the feedback!



Brandi,
Who is the intended audience for this chart?  I find it busy and somewhat confusing, and I already know how to code E/M.

Just in terms of design ... you should not mix horizontal and vertical writing, which forces someone to be constantly rotating the page to read things. 

I second the opinions that say you should separate outpatient from inpatient (though I'd include ER and Observation codes in the "inpatient" chart).

I applaud your efforts to get everything into a concise "flowchart" ... it's a Herculean task!

Hope that's helpful.

F Tessa Bartels, CPC, CEMC


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## gmuslimani (Nov 20, 2011)

I could not open the files.  Would you mind emailing them to esvagirl@hotmail.com

Thanks
Gaye Muslimani


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## rachaelprice (Feb 6, 2012)

*E/M coding in the state of Texas*

Does anyone know if the 95 or the 97 guidelines  are used in the state of Texas for E/M coding?


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## scox417 (Jun 27, 2012)

Brandi-
Do you mind emailing me too the file?  I couldn't open it.  slcox@skaggs.net. Thanks


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## kml1764 (Jun 28, 2012)

btadlock1 said:


> I had these practice questions in mind when I made this - it seems more practical when you're able to use it...
> 
> 20-day-old infant was seen in the ER by the neonatologist admitting the baby to NICU for cyanosis and rapid breathing. The neonatologist performed intubation, ventilation management and a complete echocardiogram in the NICU and provided a report for the echocardiography which did indicate congenital heart disease. Select the correct code(s) for the physician service.
> 
> ...



Just as an aside note, if a 20-day-old infant is seen in the ER, they would not go into a NICU but in a PICU.  NICUs do not usually take in infants that have already been in the "real world" due to the exposure to outside germs could cause major issues in a NICU.  This is not to say that a neonatalogist won't consult, but admission to PICU would be the more likely admitting area.  

Kris


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## btadlock1 (Jun 28, 2012)

kml1764 said:


> Just as an aside note, if a 20-day-old infant is seen in the ER, they would not go into a NICU but in a PICU.  NICUs do not usually take in infants that have already been in the "real world" due to the exposure to outside germs could cause major issues in a NICU.  This is not to say that a neonatalogist won't consult, but admission to PICU would be the more likely admitting area.
> 
> Kris



That may affect the POS code used on your claim form, but not the CPT code selection; CPT codes for neonatal and pediatric critical care are based on the patient's age & their admission status - not as much the physical location where services are being provided (except, of course, in instances where the patient is being transported from one facility to another, while critically ill). 

You would still report 99468 & 99469 for the inpatient critical care of a patient under 28 days old, even if they were admitted to the PICU area vs.  the NICU area.


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## aimie (Jul 7, 2012)

*Love it*

Suggestion:
I agree seperate e/r from observation etc
maybe turn the page into landscape
personally use a chart format wih rows and columns lines

other wise i love it especially with auditing

i hope i did not offend you with my suggestions

aimie


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