Wiki Auditing ? on E/M-

[msalvatore]

When auditing E/M levels do you as an auditor look more at the MDM and medical necessity or do you go by the CPT guidelines for choosing an E/M level.

 

[Lukelie]

You would have to know what rules the office is following. If CPT guidelines, then history, exam, medical decision making. If CMS guidelines, then medical necessity of the presenting problem is a driving factor.

 

[aleciaaa10]

The MDM is what drives the E/M code selection. For example if a new patient came in with a laceration and they happen to get a comprehensive history and do a full exam, it would not be appropriate to code, say a level 5. You look at what the patient is coming in for.

If there are other issues/conditions that arise during the visit, you can factor that in to the MDM, but just because a comprehensive history is done doesn't mean you can code a higher level. Hope that helps!