Using the EM Coding Engine

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.

Patient Type

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.

Time Indicator

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.  

Selected Code:

Code Recommended on the Superbill: