Medical Decision Making - The Logic Behind the Grid used for all Evaluation and Management Codes

The table entitled “Elements of Medical Decision Making” is a document that has some familiarity to those working in coding, billing and auditing. It was created using some of the same parts of the Table of Medical Decision Making that was an integral part of both the 1995 and 1997 Guidelines for Evaluation and Management (E&M) services. 

Portions of the new table include old parts like prescription drug management, drug therapy requiring intensive monitoring for toxicity and decision regarding major surgery. New parts in the Elements of Medical Decision Making include assessment requiring an independent historian, social determinants of health and parenteral controlled substances. Then there are parts that are somewhat like the old ones but have a twist or a new meaning like review of prior external note(s) from each unique source, decision regarding minor surgery with identified patient or procedure risk factors, and Independent interpretation of a test performed by another physician/other qualified health care professional (not separately reported). This in only mentioning parts from two of the three columns. 

The clarifying what is the same, what is new and what is different is the intent of this webinar. 

The Elements of Medical Decision Making grid has three columns and each of those has entries under straightforward, low, moderate and high. Each part or line will be discussed in a  step by step review of the entire document.

After attending this session, you will be comfortable with each of the elements of each of the three columns is the goal. 

Webinar Objectives

In order to work with the new Elements of Medical Decision Making, requires the user to understand each section and all the contents found within it. Guidance was given when changes were made in 2021 to the Office and Other Outpatient Service codes. Further guidance and definitions were given with the changes to Evaluation and Management Service codes that were made in 2023. 

This webinar with Jill M. Young will go through each line of each section so the attendees have a better understanding of that line and what interplay there is between them. Without this intimate knowledge of this intimidating table, it is impossible to effectively use it to determine the level of service accurately, whether selecting a code or auditing a code. 

Webinar Agenda

• Introduction
• Background and Evolution
• Deconstructing the Elements
• Unpacking the Table
• Practical Applications
• Key Takeaways and Conclusion
• Interactive Q&A

Webinar Highlights

• If you have two acute complicated injuries, can you move from Moderate to High?
• What is the difference is between an acute uncomplicated and an acute complicated illness?
• What does it mean when an acute illness has systemic symptoms?
• Who qualifies as an independent historian?
• What is considered a “unique test”?
• What qualifies as discussion of management on a patient?
• What does the wording “with identified patient or procedure risk factors” mean
• What does it mean to have a social determinants of health limit diagnosis or treatment?

Who Should Attend

Coders & Billers, Auditors, Office Managers, Office Administrators and Providers (physicians, NPs and PAs)