2025 Gastroenterology Reimbursement and Coding Update (Virtual) | November 2024-03

03 - E&M Examples for MDM and Time

Pdf Summary

The document is a webinar presentation by Kristin Vaughn, a healthcare consultant and auditor, focusing on medical decision-making (MDM) and time-driven visits for evaluation and management (E&M) coding. The presentation includes various clinical examples to illustrate proper coding practices in accordance with the American Medical Association’s Current Procedural Terminology (CPT) coding system. <br /><br />The presentation offers detailed examples of established and new patient assessments, both in medical offices and hospital settings. Each example identifies the complexity of the medical issues addressed, the amount and type of data reviewed, and the associated patient management risks, determining the medical decision-making level required for coding purposes.<br /><br />Clinical Example #1 discusses managing a stable chronic illness (GERD) with a low MDM level, while Example #2 presents a scenario with irritable bowel syndrome and increased anxiety, hitting a moderate MDM level. For new patients, examples illustrate more complex scenarios like undiagnosed abdominal pain and change in bowel habits, each assigned specific MDM levels according to the patient's context and the healthcare provider's interventions.<br /><br />The webinar also reviews time-driven visits, where billing is based on the total time spent on patient care rather than the complexity of decision-making. This approach is exemplified through scenarios like intensive post-hospitalization follow-ups and intricate patient-communications through a translator.<br /><br />Additionally, endoscopic risks are evaluated to determine related coding scenarios, showing how assessment and patient risk might adjust the coding to reflect minor or major medical procedures.<br /><br />The presentation underscores the importance of aligning clinical documentation with appropriate CPT codes to ensure accurate medical billing and auditing, reflecting the intervention's complexity and effort.

Keywords

medical decision-making

E&M coding

CPT coding system

patient assessments

clinical examples

time-driven visits

auditing

Kristin Vaughn

healthcare consultant

medical billing