My suggestion would be to make a copies of a few notes so that you can mark them up. Take your audit tool and go through the notes marking just the HPI elements (you only need four for a comprhensive so don't go crazy trying to find every single element). Then with a differnet color go through and mark the ROS, history and exam (all with different colors). Once you have done this then look at the MDM, how many problmes did the patient present with, are they chronic or new, is this a new patient to the provider? What types of test did the provider review or order, did he have to obtain info form other sources? Then the risk, I find this is the most subjective part of the MDM, bur use the Table of Risk on the audit tool and that should help.
Once all of the other things are done use your audit tool to determine your E/M code. For New patients or Consults 3 of the elements HPI, Eam and MDM must meet or exceed the requirements, for established you only need two out of three. It will take awhile and you will be slow at first, but the more you practice the easier it will become. I suggest different colors for each element because that will help them to stand out to you. Also each doing each element separately will help you learn to break down the notes since they are not always arranged like we would want them. Hope this is helpful.
Doreen, CPC