Billing and Coding Flashcards
E/M level 1 (new)
History - problem focused
Physical Exam - Problem focused
MDM - straightforward
E/M level 2 (new)
History - extended problem focused
Physical Exam - extended problem focused
MDM - straightforward
E/M level 3
History - detailed
Physical Exam - detailed
MDM - low complexity
E/M level 4 (new)
History - comprehensive
Physical Exam - comprehensive
MDM - moderate complexity
E/M level 5 (new)
History - comprehensive
Physical Exam - comprehensive
MDM - high complexity
Straightforward MDM complexity
Problem points: 1
Data points: 1
Risk: minimal
Low MDM complexity
Problem points: 2
Data points: 2
Risk: low
Moderate MDM complexity
Problem points: 3
Data points: 3
Risk: moderate
High MDM complexity
Problem points: 4
Data points: 4
Risk: high
Minimal risk
one self-limited or minor problem
Low risk
2+ self-limited or minor problems
1 stable chronic illness
acute uncomplicated illness or injury
ex: ankle sprain, UTI, rhinitis
Moderate risk
1+ chronic illnesses with mild exacerbation or progression
2+ stable chronic illnesses
Prescription drug management
undiagnosed new problem with uncertain prognosis
acute illness with systemic symptoms
acute complicated injury
High risk
1+ chronic illnesses with severe exacerbation or progression
acute or chronic illness or injury that pose threat to life or bodily function
2 data points
for independent review of an image, tracing, or specimen.
review and summation of old records.
data points for both ordering and independently reviewing an image or ECG
2
1 data point
review/order lab test.
review/order radiology.
review/order medicine test.
discuss test with performing physician.
decision to obtain old records.
1 problem point
self-limited or minor
stable established problem
2 problem points
worsening established problem
3 problem points
new problem with no additional workup planned
4 problem points
new problem with additional workup planned
Problem focused physical exam
1-5 bullets/findings
1+ organ systems
EPF physical exam
6+ bullets/findings
1+ organ systems
Detailed PEx
12+ bullets/findings
2+ bullets in 6+ systems
Comprehensive PEx
18+ bullets
2+ bullets in 9+ systems
Problem focused Hx
HPI: 1-3 elements
ROS: none
PFSH: none
Extended problem focused Hx
HPI: 1-3 elements
ROS: 1 system
PFSH: none
Detailed Hx
HPI: 4+ elements or chronic conditions
ROS: 2-9 systems
PFSH: 1/3 pertinent PFSH
Comprehensive Hx
HPI: 4+ elements or 3 chronic conditions
ROS: 10+ systems
PFSH: 3/3 complete PFSH
How many components are required for a new patient to meet a level of care?
3/3
History, PEx, and MDM all have to be a certain level or higher.
How many components are required for an established patient to meet a level of care?
2/3
2/3 components have to be a certain level or higher.
CPT codes
992_ _
992 (0 for new, 1 for estab) (E/M level 1-5)
Clinical E/M levels
based on time spent coordinating care.
must record duration of encounter
document in detail the counseling and coordination of care that occurred
