The EM Coding engine will coach a user on which Evaluation and Management code to use for the current visit based on the work completed during the visit. Based on the selection made, the EM Coding engine will push the recommended code to the Superbill so that this code can be billed as part of the visit.
As of January 1st, 2021, the EM Coding engine only consists of Medical Decision Making. Prior to January 1st, 2021, the EM Coding engine also had categories for History and Exam. Due to rule changes at CMS, these two categories have been removed. Learn more here: 2021 EM Coding Guidelines - Our Plan
If the EM Coding engine has been enabled for your practice, users may decide to turn the EM Coding engine on or off. If the EM Coding Engine has not been enabled for your practice, please contact firstname.lastname@example.org to have this added.
- Navigate the EMR portal
- Open any patient chart
- Right click over the section on the right hand side of the screen
- Select Setup Sections
- Use the Setup Section screen to make the desired changes
- To turn the EM Coding engine on, be sure the Enabled box is selected. Otherwise, turn it off.
- To have the EM Coding engine always expanded, be sure the Expanded box is selected. Otherwise, turn it off.
- Click Save
The EM Coding engine is designed to guide a user to select the correct Evaluation and Management CPT code for the desired visit. This article will describe the various features and functions of the tool.
Date of Service (DOS)
The Date of Service is set based on the Encounter Date established in the EMR. Encounter Dates are most often set by opening a patient from a scheduled appointment. When the DOS is set to 1/1/2021 or greater, the EM Coding engine will run based on the 2021 EM Coding guidelines. Prior to 2021, the EM Coding Engine will run based on the legacy rules.
The Patient type selection consists of New and Established. This is set by determining if the patient has had a claim in the system within the last 3 years. If a claim exists, Est. is automatically selected. If a claim does not exist, New is set. Changing these options will modify the codes that will be suggested. Users may override the selection as necessary.
The EM Coding rules allow for a provider to bill based on time spent with a patient or based on the complexity of the medical decision making process invoked as part of the visit. Providers that wish to bill based on time should check the 'Time' checkbox. The EM Coding Engine guidelines will change based on this selection.
Time Indicator on:
Time Indicator off:
EM Coding Guidance link
For providers that wish to bill based on the complexity of the Medical Decision Making process invoked during the visit, you may find it helpful to click the MDM link at the bottom of the wizard. This will display a series of categories that make up the MDM component. The categories include problems assessed, data reviewed, and risk. Hovering over the various levels within each category will display guidance at the bottom of the screen to help the user choose the correct option. Making a selection in all 3 of the categories will determine the correct EM Code to use.
EM Code Pushed to Superbill
The EM Code selected (highlighted in orange) using the EM Coding Engine will be pushed to the Superbill. When the Superbill chart tab is opened, the user will be prompted to add this code to at that time.
Code Recommended on the Superbill: