Author Topic: The 3 stooges Method of E/M Selection  (Read 1104 times)

Steve Verno CMBS, CEMCS

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The 3 stooges Method of E/M Selection
« on: September 24, 2009, 09:29:36 AM »
This is an area many people dont understand.  You have three key components.  History, Exam and Medical Decision Making. 
 
You need to look at the E/M code you wish to select.  Look to see if you need 2 out of the 3 key components or do you need all three key components to select the E/M.  Office visits for new patients usually require all 3 key components.  Emergency E/M requires all 3. 
 
So, you have 3 different levels before you. You have an Expanded Problem Focused (EPF) History, A detailed Examination, and a High Medical Decision Making (MDM).  So, what E/M level do you select??? 
 
 
Another way of looking at this is steps.  You have 3 people. Larry Moe and Curley.  To select the level of stairs is that all 3 people have to be on the same level of steps at the same time.  Larry only has 1 step.  Moe has 2 steps and Curley has 5 steps.  Larry cant go any higher because all he has is 1 step.  Moe has 2 steps, so to be at the same level as Larry, he walks down 1 step and stands beside Larry at the first step.  Curley has to go down 4 steps to stand beside Larry and Curley on step 1. 
 
Get back to the E/M. 
 
YOU have EPF History  (2 steps), you have detailed examination (3 steps) and you have High MDM (5 steps),  larry is at step 2 and cant go higher.  Moe and Curley step down until they are side by side with Larry at Step 2.  You look and see that step 2 is 99202. 
 
Lets say you need 2 out of 3 at the same level as with an established office visit patient. 
 
Larry is at step 2.  Moe is at 3 steps, and Curley is at 5 steps.  Curley can go down a few steps until he is standing at the same step as Moe.  2 out of the 3 stooges are now at the same level. 
 
Lets do a few fun examples:
 
This is an Emergency Department Visit (3/3 required)
 
Larry (History)  EPF (99282)
Moe (Exam)  EPF (99282)
Curley (MDM) High (99285)
 
Curley drops down to step 99282 so your E/M would be 99282
 
Larry (History)  EPF (99282)
Moe (Exam)  Detailed (99284)
Curley (MDM) High (99285)
 
Moe and Curley drop down to step 99282 so your E/M would be 99282
 
Larry (History)  Comprehensive (99285)
Moe (Exam)  Detailed (99284)
Curley (MDM) Problem Focused (99281)
 
Moe and Curley drop down to step 99281 so your E/M would be 99281
 
I hope this helps
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