I have a few tips. First, get the 1995 and 1997 guidelines and read them thoroughly. Secondly, check your payer to see if they have any other guidelines that clarify or differ from CMS, and get a copy of their audit tool. Understanding E/M is accomplished through practice, so it might make sense for you to purchase the study guide for the AAPC's CEMC certification, or contact your local AAPC chapters to see if anyone is offering a presentation on how to audit E&M services.
Level of service is determined by several factors...new/established patient, service location, key components and nature of presenting problem. Overall, most payers suggest you use MDM as your overarching indicator of LOS, but medical necessity must play the primary role in determining service level. Navigating MDM is tricky....but once you learn how to plug in your diagnoses/treatment options, your data, and how to read the table of risk (the highest box you check...not 2/3) then you can determine MDM based on two out of three elements of MDM. From there, measure your exam (determine if 97 or 95 is more advantageous) and your HPI to see if you can match your MDM level. Using the audit tool is crucial.
If you're anywhere near northern New England, I'm giving a presentation on E&M in November at our local chapter meeting, but that's a common topic and I'm willing to bet that one of the chapters in your area is also providing the same topic at some point soon. If not, check the AAPC since they offer many on-demand webinars with the topic of E&M that will help you.
