E&M Medical Coding — How to Level E&M Code (Part 2)
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The other part of the story that we need to think about is “3 of 3” versus “2 of 3.” That’s very critical to getting the right levels. If you look here, it says, “which requires these three key components” and you’ll notice it says that “for each and every single description.” So this is a subcategory that the E&M guidelines are telling us that we have to meet or exceed every single bullet in order to code it; so, for example a level five, we need a comprehensive history, comprehensive exam and high medical decision making. If we only have moderate medical decision making, then we have to bump down to a level four, because we meet the first two bullets, but we don’t meet the third bullet; so we got to go down to the lowest one.
And that’s what this little rhyme is: When it’s 3 of 3, code to the lowest – the lowest is always going to pull it down because of this which requires these three key component statement. So, look at that again. Let’s pick another one, what if you had a DCH? What you’re going to do for this system, DCH (detailed history, comprehensive exam, and high medical decision making); so when you look at that, what I do is I say, “OK, the D shows up at a level 3.” I’m not assigning a level three yet, I’m just saying, “So far, it’s a level three.” The “C” makes it a level four and the “H” makes it a level five; but if I try to make it fit a level five, the first two bullets don’t meet or exceed, so we have to scratch that one off. If we look at the level four, we only have 2 of 3 bullets, so we have to code to the lowest, it’s going to be a level three.
So that’s why the saying is: When it’s 3 of 3, code to the lowest. If you had a PCH, you got to code it on level one even though the other two elements are level five. Now, hopefully, documentation won’t be like that because that means a physician needs some education on documentation. Normally you’ll see them stair step along with each other, but there could be some wild permutations that way.
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