ENM1



#### 1. **Overview of E/M Services**
   - E/M codes (99000 series) are for "evaluation and management" – essentially, doctor-patient consultations where the physician assesses problems, reviews data, and manages care.
   - Not for procedures or surgeries; those have separate codes.
   - Divided into **Outpatient (OP)**: Patient not admitted to hospital (e.g., clinic visit).
   - **Inpatient (IP)**: Patient admitted to hospital (stays 24+ hours or crosses midnight).
   - Purpose: To bill for the time and complexity of the visit.

#### 2. **Outpatient (OP) Visits**
   - Patient sees doctor without admission (e.g., for check-up, medicine prescription).
   - Subdivided into:
     - **New Patient**: First time visiting the same specialty or sub-specialty in 3 years.
       - Codes: 99202–99205.
       - Examples:
         - 99202: Straightforward MDM, 15–29 minutes.
         - 99203: Low MDM, 30–44 minutes.
         - 99204: Moderate MDM, 45–59 minutes.
         - 99205: High MDM, 60–74 minutes.
     - **Established Patient**: Follow-up within 3 years.
       - Codes: 99211–99215.
       - Examples:
         - 99211: Minimal (nurse-only, no doctor required), 5 minutes.
         - 99212: Straightforward MDM, 10–19 minutes.
         - 99213: Low MDM, 20–29 minutes.
         - 99214: Moderate MDM, 30–39 minutes.
         - 99215: High MDM, 40–54 minutes.

#### 3. **Inpatient (IP) Visits**
   - Patient admitted to hospital.
   - Subdivided into:
     - **Initial Visit**: Doctor's first visit after admission.
       - Codes: 99221–99223.
       - Examples:
         - 99221: Straightforward/Low MDM, 40 minutes.
         - 99222: Moderate MDM, 55 minutes.
         - 99223: High MDM, 75 minutes.
     - **Subsequent Visit**: Follow-up visits during stay.
       - Codes: 99231–99233.
       - Examples:
         - 99231: Straightforward/Low MDM, 25 minutes.
         - 99232: Moderate MDM, 35 minutes.
         - 99233: High MDM, 55 minutes.
   - **Same-Day Admit/Discharge**: If admitted and discharged same day.
     - Codes: 99234–99236.
     - Examples:
       - 99234: Straightforward/Low MDM, 45 minutes.
       - 99235: Moderate MDM, 55 minutes (transcript says 70, but standard is ~55+).
       - 99236: High MDM, 85 minutes.
   - **Discharge Codes**: Separate for final discharge day (e.g., 99238: ≤30 minutes; 99239: >30 minutes).

#### 4. **Medical Decision Making (MDM)**
   - Core factor for selecting code level (along with time).
   - MDM levels: Straightforward, Low, Moderate, High.
   - Determined by 3 elements:
     - **Number and Complexity of Problems**: How many issues? Acute/chronic? Simple or dangerous (e.g., requiring surgery)?
     - **Data Reviewed**: Previous records, X-rays, scans, labs, historian input (e.g., family), new orders (e.g., ECG, MRI).
     - **Risk Management**: Treatment risk – e.g., prescription drugs, injections, surgery? Low risk (tablets) vs. high (surgery, IV drugs).
   - Example: High MDM if multiple complex problems, extensive data review, and high-risk treatments like surgery.

#### 5. **Time-Based Coding**
   - Total time spent on the date of encounter (face-to-face + non-face-to-face, like reviewing charts).
   - Must meet or exceed the time threshold for the code.
   - Used when time dominates the service (e.g., counseling >50% of visit).

#### 6. **Telemedicine (Telehealth)**
   - For remote visits via audio/video or audio-only.
   - Codes: 99421–99423 (online/digital) or specific telehealth codes.
   - Subtypes:
     - **Audio + Video** (e.g., video call): Similar to in-person, new/established patient.
       - New: 99202–99205 equivalents (15–60 minutes).
       - Established: 99212–99215 equivalents (10–40 minutes).
     - **Audio-Only** (e.g., phone): Separate, e.g., 99441–99443 (5–30+ minutes).
   - Check MDM and time; specify if new or established patient.

#### 7. **Modifiers Mentioned**
   - Modifiers adjust codes for special circumstances:
     - **-24**: Unrelated E/M during post-op period (e.g., new problem after surgery).
     - **-25**: Significant, separately identifiable E/M on same day as procedure (e.g., consultation + minor surgery).
     - **-27**: Multiple E/M encounters on same day (e.g., unrelated visits).
     - **-51**: Multiple procedures in one session.
     - **-59**: Distinct procedural service (e.g., same procedure on different body parts, like ultrasound on two features).
     - **-79**: Unrelated procedure during post-op period.
     - **-80/-81/-82**: Assistant surgeon (full/minimal).
     - **-91**: Repeat lab test (e.g., blood sugar before/after meal).
   - Use when documentation supports (e.g., physician report notes assistant involvement).

#### 8. **Coding Process Flow**
   - Step 1: Determine OP vs. IP.
   - Step 2: New vs. Established (for OP) or Initial vs. Subsequent (for IP).
   - Step 3: Calculate MDM level (problems + data + risk).
   - Step 4: Factor in total time if applicable.
   - Step 5: Apply modifiers if needed.
   - Always document clearly for insurance reimbursement.

#### Additional Notes from Transcript
- The lecture emphasizes practical examples: e.g., patient visits for problems, reviews X-rays, prescribes meds/injections/surgery.
- Mentions "hospital visits" like OP (outpatient) vs. IP (inpatient).
- Stresses 3-year rule for new vs. established.
- References CPT book front for codes.
- Ends with exam prep on CPT intro and modifiers; suggests highlighting and screenshots.

If this is from a class or certification (e.g., CPC exam prep), focus on practicing with real charts. The transcript has ASR errors (e.g., "enm" for E/M, "mడిఎం" for MDM), but the core info aligns with standard guidelines.

If you have a specific question (e.g., "Explain code 99214" or "Correct the transcript"), let me know! Or if you meant to attach the full PDF for analysis, upload it for tool-based review.

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