How to select a Level of Service using the 2023 AMA E/M CPT Guideline

This video reviews the new 2023 AMA E/M CPT Guideline changes that take effect 1/1/2023, goes through the process of selecting a level of service and assigning a CPT code for different types of inpatient and ambulatory visit types.
The process is demonstrated using specific case examples while modeling the use of my free online coding calculator which can be accessed at: www.providercodeit.weebly.com
Finally, time-based billing is reviewed with demonstration of typical time tables and explanation of prolonged service codes.
***Erratum: In the 3rd and final example (the 46 yo with COPD), I erroneously give a data point for pulse oximetry. The guideline states Pulse Ox does not count as a data point. Therefore there are only 2 data points (low complexity=level1). So the overall level will be level 1 (problem level 1, data level 1, risk level 2 so overall 2/3 = level 1). My apologies for the error.

[@JordanWilliams-ix2td]

currently studying to be a medical coder & this helped me TREMENDOUSLEY THANK YOU! may you be blessed for eternity Sir 😘 😘

[@dostrovsky1]

Wow! Thanks for that. I feel blessed whenever I’m able to help someone. Good luck in your studies!!

[@shabishablol5802]

Me too. But I’m having problem understanding the MDM part
: (

[@Agbann]

This video was very straightforward and easy to understand

[@dostrovsky1]

Much Appreciated!

[@SarahM906]

I’m a new coder for our ED. This is one of the best explanations I have seen. Thank you! Saving for future reference 😊

[@dostrovsky1]

Thank you! I appreciate it and am glad it is useful for you.

[@samw8452]

Thank you!!

[@SAZZ195]

Best one

[@dostrovsky1]

Thanks so much!

[@suzettemaragh8528]

thank you great explanation

[@dostrovsky1]

Glad it was helpful!

[@azppmd]

In the last MDM example, you do NOT get to count pulse oximetry as a data point. Therefore, it's only a level 1 subsequent inpatient visit, not level 2 overall (1+1+2 => 1).
"For the purpose of data reviewed and analyzed, pulse oximetry is not a test." - AMA CPT Evaluation and Management (E/M)
Code and Guideline Changes effective January 1, 2023.
Overall, very nicely done presentation.

[@dostrovsky1]

Thank you for catching this! I apologize for the error. I will fix this in a future update and put a note in the video explanation.

[@shabishablol5802]

I’m studying coding now and I’m having problem understanding the MDM part
Why and how the example you showed : low, moderate, high… why the answer is moderate? Which two out of three is in the moderate?

[@dostrovsky1]

Hi. I’m assuming you are talking about example 2. All 3 problem, data, and risk are moderate. Moderate problem due to clinical presentation having systemic findings such as fever and decreased urination. A different provider may have deemed this a low complexity problem and there is subjectivity involved. It is the provider’s prerogative in making the selection for each individual case using the guidance provided by the guideline (I discuss this at the end of the example). Data is moderate because there is a UA, urine culture, and a parent providing history. Risk is moderate due to prescription drug management. So overall the level would be moderate (level 4) hope that helps. Thanks for watching. Try the calculator on my website and play around with changing things to see how it affects your final code.

[@jessicacolon1376]

Thanks

[@dostrovsky1]

You're welcome!

[@tracyhilt3442]

Thank you

[@dostrovsky1]

You're welcome

[@tracyhilt3442]

@@dostrovsky1 question for the data table the problem is high and the data should be moderate as 2 tests are reviewed and 1 outside source and the risk was moderate should be a level 99222 correct. My coding team notes a hight level for the data but it notes 1 out of the 3 categories any combination of the 3.

[@dostrovsky1]

Hi ​ ​ I’m not sure I understand your comment. I assume you are referring to the last example. Again to summarize…. A hospitalized patient responding to treatment would be a low for problem. Pulse ox, cbc,metabolic panel 3 points is moderate for data, and antibiotics, steroids, and breathing treatments carry moderate risk in my opinion. This yields level 1 problem, level 2 data, level 2 risk. 2/3 at or above 2 so overall level 2 with subsequent visit CPT 99232. Hope that makes sense.

[@tracyhilt3442]

@@dostrovsky1 thanks much

[@jayapradhakesarkar4032]

Thanks for explanation. But I have one doubt sir. For a new patient if the problem is not addressed in assessment but renewed his medication for his ADHD which is documented in Hpi, can i consider that as problem addressed ? Also addressed htn in impression, can i consider this as level 4? Please help me

[@dostrovsky1]

Great question. There are no documentation requirements for selecting your level. However, simply refilling a medication without it being "evaluated" in the encounter would not be appropriate. As you describe, there is some documentation that you evaluated the problem, and, while good practice to document your assessment/plan which could be as simple as "stable ADHD, refilling med" there is no requirement that you specifically document a plan. So if you evaluated 2 stable chronic problems and performed prescription drug management, that would be a new level 4 99204 based on problems and management.

[@SarahAnnBellham]

I'm sure there are people still using the risk grid.

[@sreeshmasreeshma7993]

Thanks

[@dostrovsky1]

Thanks for watching!