First know the 2024 updates:
The E/M Services Guidelines for 2024 include several significant changes that healthcare professionals need to be aware of:
Time Ranges Removal for Office Visit Codes: The existing time ranges for office visit codes will be replaced with threshold times. This adjustment aims to standardize these codes with the rest of the level-based code set, making coding more straightforward and reducing the administrative burden on practitioners (Decision Health).
Revised Guidelines for Split/Shared Visits: There are updates specifically for split/shared visits, which are applicable only in facility-based settings. These modifications are designed to align with Medicare’s current definition of substantive portions and address split/shared visits based on time and medical decision-making (MDM) (Decision Health). A split/shared visit is characterized by services performed partly by a physician and partly by a non-physician practitioner (NPP) in the same group practice, applicable only in facility settings. The reporting of such visits is detailed, focusing on the substantive portion of the encounter and the total time spent on various patient-related activities by the physician or NPP (ACS).
Guidance for Reporting Same-Day Services and Inpatient/Observation Services: The updates will include a chart offering clarity on how to report inpatient and observation stays based on the length of the stay (Decision Health).
Additionally, for time-based coding, the activities that count towards documentation have remained consistent with the previous year. These include preparing to see the patient, obtaining/reviewing separately obtained history, performing medically appropriate examinations/evaluations, counseling and educating the patient/family/caregiver, ordering medications/tests/procedures, referring and communicating with other healthcare professionals, documenting clinical information in the EHR, independently interpreting results, and coordinating care. It's important to note that time spent on other separately reported services, travel, or general teaching does not contribute to this documentation (MGMA Homepage).
These changes aim to reduce the administrative burden on treating practitioners and align more closely with CMS guidelines. Practices should prepare for these adjustments and also anticipate major changes in how telehealth visits are reported in 2025, with the introduction of new telemedicine codes (Decision Health).
For detailed guidance on adapting to these changes, healthcare professionals are encouraged to refer directly to the sources provided by the American Medical Association (AMA) and other healthcare regulatory bodies.
Understanding Medical Decision Making (MDM) is crucial for accurate coding and billing in healthcare.
The E/M Services Guidelines for 2024 bring specific updates that educators and students must grasp. This blog provides a simplified approach to understanding MDM through multiple-choice examples, reflecting the 2024 guidelines. Mastering Medical Decision Making (MDM) with E/M Services Guidelines 2024 with Examples
What is Medical Decision Making (MDM)?
Medical Decision Making refers to the complexity of establishing a diagnosis and selecting a management option for a patient. It's based on three components:
The number and complexity of problems addressed during the encounter
The amount and/or complexity of data to be reviewed and analyzed
The risk of complications and/or morbidity or mortality associated with the patient's problem(s), the diagnostic procedure(s), and the selected management options
Multiple Choice Examples on MDM
Example 1: Number and Complexity of Problems Addressed
Dr. Smith evaluates a patient with chronic heart failure and newly diagnosed diabetes. Considering the E/M Services Guidelines for 2024, how would this scenario likely be categorized in terms of Problems MDM complexity?
A) Minimal B) Low C) Moderate D) High
Correct Answer: D) High - Managing multiple significant problems in a single encounter generally indicates a higher complexity of MDM.
Example 2: Amount and/or Complexity of Data to Be Reviewed
If Dr. Jones reviews and analyzes a comprehensive panel of blood tests, a new MRI of the brain, and consults with two specialists regarding a patient's condition, what level of Data MDM does this scenario reflect?
A) Minimal B) Low C) Moderate D) High
Correct Answer: C) Moderate to D) High - The review and analysis of extensive data, especially involving consultations with specialists, suggest a higher complexity of MDM. The exact level may depend on other factors as well.
Example 3: Risk of Complications and/or Morbidity or Mortality
A patient presents with a high fever and severe abdominal pain. The physician orders an urgent CT scan suspecting appendicitis, which if confirmed, may require surgery. How is the Risk MDM complexity categorized in this scenario?
A) Minimal B) Low C) Moderate D) High
Correct Answer: D) High - The potential for surgery due to a suspected serious condition implies a high risk of complications, indicating a high complexity of MDM.
Example 3: Data MDM
CHIEF COMPLAINT: Right knee pain
A medically appropriate history and exam is performed.
ANCILLARY STUDIES: Radiographs of the right knee obtained in our office today, show advanced degenerative arthritic changes of the knee. She has multicompartmental involvement with noted bone-on-bone contact laterally. Overall bone mineralization quality is decreased, no fractures.
IMPRESSION: Advanced right knee degenerative primary arthritis.
PLAN: We have discussed operative treatment through total knee replacement versus nonoperative treatment through therapy and injections. Patient wishes to proceed with Orthovisc injections. She will return to begin her injection series in approximately one week.
The provider billed globally for the X-ray.
What is the level for the amount and complexity of data to be reviewed and analyzed?
Answer: A. Minimal or None
The provider ordered an X-ray. It appears the provider may have read the X-ray but because the provider’s office billed for the X-ray, this is not included in the MDM. One order for an X-ray result falls under minimal or none for the level of number and complexity of data to be reviewed and analyzed.
Lets take all that we have learned to do an Overall MDM with code selection.
Dr. X is in an assisted living facility for a follow-up visit on an established elder patient he had seen a few days ago. The patient had stepped on a nail on the grounds of the facility three days ago which went in the right foot. Staff has been cleaning and soaking it. Patient is taking the antibiotics prescribed.
No weight change, fever, chills, no numbness or tingling, no joint swelling.
Foot- Right foot entrance puncture wound, mild erythema. No foreign body notes. Toes and ankle full ROM.
Final Diagnosis: Aftercare for a puncture wound, right foot. Healing well with no infection.
PLAN: Soak QID wash with soap and water, continue with Rx for Augmentin and continuing resting foot not walking on it. Call with any new concerns. Will return in 5 days.
What is the E/M code for the office visit?
A.99347
B.99348
C.99307
D.99308
Answer: A. 99347
Medical Decision Making: OVERALL: STRAIGHTFORWARD COMPLEXITY
Number of Diagnoses/Treatment Options – Low: Stable, acute illness
Amount and/or Complexity of Data – None
Table of Risk – Minimal Level of Risk - Resting foot
2 of the 3 MDM elements must meet or exceed for the overall MDM level.
For the coding scenario, you have: Straightforward MDM
99347
Key Takeaways from the E/M Services Guidelines 2024. Mastering Medical Decision Making (MDM) Medical Coding with E/M Services Guidelines 2024 with Examples
Threshold Times: Office visit codes now use threshold times instead of time ranges, simplifying time-based documentation.
Split/Shared Visits: Revised guidelines apply solely to facility-based visits, focusing on time and medical decision-making.
Same-Day Services and Inpatient/Observation Services: New clarifications help in reporting based on the length of stay (Decision Health) (ACS).
Conclusion
The E/M Services Guidelines for 2024 emphasize a structured approach to evaluating Medical Decision Making. These guidelines not only aim to streamline the coding process but also ensure accuracy and compliance, ultimately benefiting patient care and healthcare management. I hope this helps Mastering Medical Decision Making (MDM) Medical Coding with E/M Services Guidelines 2024 with Examples.
Want more E/M Examples? Click below and download my Evaluation Management Study guide.
Or my page by page AMA CPT notes that you can add to your manual prior to your certification exam.