NextGen Knowledge Center

Calculate an E&M Code Under 97 Coding Guidelines

You can base the Evaluation and Management (E&M) code calculation on the selected Medical Decision Making (MDM) level and documented history and physical exam elements or on the total visit time if more than 50 percent of the time was spent counseling or coordinating care.
  1. Open the Finalize (BH) template and then expand the Evaluation and Management Coding panel.
  2. Enter a start and end time.
    The duration calculates and displays in the corresponding field. When you enter a start and end time initially, the Time visit time (minutes) field updates with the same value. If you then edit the Time visit time (minutes) value and manually select an E&M code, the updated time overrides the original time entered.
  3. To calculate the E&M code based on the MDM Level and documented history and physical exam elements, select the level of complexity associated with the encounter in the Medical Decision Making section.
  4. For guidance in determining the level of complexity involved in MDM, select the View MDM Guidelines link.
  5. For guidance in determining the level of risk associated with the encounter, select the View Risk link.
  6. To calculate the code based on the total visit time, do the following:
    1. Enter counseling and educational details.
      The total time spent for counseling appears in the Total counsel time (minutes) field.
    2. To modify the Total visit time (minutes) value calculated in step 2, select in the field and enter the total time in minutes.

    You must enter a total visit time at least equal to the total counseling time; otherwise, an alert appears.

    The total time appears in the Total visit time (minutes) field.

    If the total counseling time is greater than 50 percent of the total visit time, the application selects the Counseled greater than 50 percent of time and documented content checkbox.

    If the total counseling time is less than 50 percent of the total visit time, an alert appears, and the Evaluation and Management Coding panel displays a message that the E&M code cannot be calculated based on time. You must select an MDM level to calculate the code.

  7. In the Evaluation and Management Code section, select Calculate Code.
    The application selects the corresponding code in the code option section at the bottom of the Evaluation and Management Coding panel. The code appears in the first Visit code field and in the Calculated E&M code field.