Calculate E&M Codes under the 95 or 97 Coding Guidelines
You can base the E&M code calculation on the selected Medical Decision Making (MDM) level, 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.
- Open NextGen® Enterprise EHR.
- For a patient record, open a new encounter.
- Open the Finalize template.
- On Evaluation and Management Coding, do one of the following:
- To calculate the E&M code based on the MDM Level, documented history, and physical exam elements, select the level of complexity associated with the encounter in the Medical Decision Making section.
For guidance in determining the level of complexity involved in MDM, you can select the View MDM Guidelines link and the level of risk associated with the encounter, select the View Risk link and refer to the details.
- To calculate the code based on the total visit time, do the following:
- Select Counsel Details and enter counseling and educational details on the Counseling Details template.
The total time spent on counseling appears in the Total counsel time (minutes) field.
- Select Total visit time (minutes), enter the total time in minutes, including counseling time, and then select OK.
Note: You must enter a total visit time at least equal to the total counseling time; otherwise, an alert appears. 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 check box. 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 and you must select an MDM level to calculate the code.
- Select Counsel Details and enter counseling and educational details on the Counseling Details template.
- To calculate the E&M code based on the MDM Level, documented history, and physical exam elements, select the level of complexity associated with the encounter in the Medical Decision Making section.
- In the Evaluation and Management Code section, select Calculate Code.
The application selects the corresponding code in the code option section of the Evaluation and Management Coding panel. The code appears in the first Visit code field and in Calculated E&M code.Note: The NextGen® Adaptive Content Engine assigns code 99211 Nurse Visit based on the visit type only, not the MDM level or time.