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E&M coding? - Is E&M

Posted: Apr 16, 2012

Is Evaluation and management coding hard to learn?

It can be, and is why some coders have great jobs - Why do you ask?

[ In Reply To ..]
It helps if you explain why you are asking. Are you in a course that is making no sense? Are you an inpatient coder who needs to learn E/M? Are you planning to make a career decision based on this, i.e. if it is hard you plan to become a florist instead? Have you even seen the codes yet or did someone warn you? ;)

Advising on E/M can be lucrative, so your efforts can pay off.

Some, but not all, E/M codes can be confusing. The codes that are based on time are fine, as are the relatively straightforward ones like observation. Preventive medicine services, for instance. How hard is it to choose a code by the age of the patient?

The problem is the ones that say things like problem-focused and straightforward. The code bok explains what it means by that. It also provides an appendix of examples so you can figure it out by comparison. It mostly leaves the definitions up to the physician's judgement.

As long as you are using only the code book itself, it is pretty much a no-brainer. The problem is that Medicare thought there was too much leeway for opinions and ... gasp! ... abuse. Doctors overestimated the value of their services. In 1995 CMS came out with a set of guidelines that defined complex, straightforward, etc. and decreed what documentation would support that. Doctors hated it, so in 1997 CMS issued a second set of guidelines. (Get both sets off the internet. Just google.) Doctors hated that, too. CMS now lets you choose whicheveer set is most advantageous for you.

Some coding textbooks do not make this history clear. They do not say what is the AMA view and what CMS added on. Some make the whole mess even more difficult by asking irrelevant questions or expecting you to memorize almost random combinations of definitions and numbers of things. Some authors have never coded in their lives and it shows in the textbooks.

I recommend that you separate out the codes that are discussed in the aforementioned CMS E/M guidelines. Everything else is easy Make a chart of the easy ones. You can just choose those without fuss. Next make a chart of the rest. It will include new patient visits, est pt visits, admission day services, emergency, and so forth. Now figure out what you need for documentation and medical decision making. Put those on your chart.

Doing that will help you see what these are. Reading books about this is not all that useful. You have to do the work of sorting this out on your own. Once you do that, you will feel better about this.

Inpatient - coder

[ In Reply To ..]
Have always done inpatient/facility coding, never physician coding. I studied it briefly once, but never used it. I didn't like it. I was glad not to ever have to do it. It goes against what my brain likes somehow. It seems too convoluted. I'm checking into a new job where they do everything and E&M part of it.

It can be w/o the right resources - soon2b

[ In Reply To ..]
How funny, I clicked on this link and it was just the OP's only, then I noticed someone elses reply at the next second.. wow.

I'm learning it right now, and yes it's hard, but you get it down pat if you have the proper AMA guidelines for 1995/1997 E/M

E/M - Anonymous

[ In Reply To ..]
I thought it was and still struggle with it but not everyone finds it difficult.

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