2023 Gastroenterology Reimbursement and Coding Update (Virtual) | November 2022-E&M Examples for MDM and Time

Pdf Summary

During a presentation by Kristin Vaughn, various clinical examples were provided to demonstrate medical decision making and time-driven visits in the field of E&M (evaluation and management). The examples covered a range of scenarios, including established patients and new patients, as well as specific conditions and treatment plans. The medical decision making levels were determined based on the number and complexity of problems addressed, the amount and complexity of data reviewed and analyzed, and the overall risk of complications or patient management.<br /><br />For time-driven visits, it was explained that clinicians can count the time spent on various activities on the day of the patient's visit, including preparation, examination, ordering medications and tests, and documenting in the patient's medical record. The total time spent by the physician or qualified healthcare professional on the date of the encounter determines the E&M code for billing purposes.<br /><br />Clinical examples were provided to illustrate time reporting for billing. One example involved a patient with ulcerative pancolitis who had experienced severe symptoms while on vacation and was hospitalized in Florida. The gastroenterologist spent a total of 45 minutes on the day of the follow-up visit, including reviewing hospital records, obtaining history and examination, and documenting the visit. This was coded as a level 5 (99215) based on time spent.<br /><br />There was also discussion of the risks associated with endoscopy procedures. Examples were given to demonstrate how the complexity of problems and the risk associated with the procedure can impact the level of medical decision making. The examples covered scenarios such as upper GI endoscopy, lower endoscopy, and an emergent ERCP for stent placement in a patient with pancreatic cancer.<br /><br />Overall, the presentation provided insights into medical decision making and time-driven visits, offering practical examples to enhance understanding in the field of E&M coding and billing.

Asset Subtitle

Kristin Vaughn, CPC, QMC, QMGC, CPMA, ICDCT-CM

Keywords

clinical examples

medical decision making

time-driven visits

E&M

established patients

new patients

complexity of problems

time spent

coding

risks