Determining Medical Decision Making Levels

Table Name	Definition
Nature of Presenting Problem (Table A)	Lists the number of possible diagnoses and the management options that must be considered. This table helps you determine the complexity of the patient's problem.
Data Reviewed and Analyzed (Table B)	Lists the amount and complexity of medical records, diagnostic tests, and other information that must be obtained, reviewed, and analyzed. This table helps you determine the complexity of the reviewed and analyzed data.
Patient Management (Table C)	Lists the risks associated with the patient’s presenting problem, the diagnostic procedure, and the possible management options. This table helps you determine the risks of complications and morbidity or mortality of the patient.

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Review and Modify Medical Decision Making Levels

You can review and determine the complexity of a patient's health from the overall medical decision making (MDM) level. Before you begin Ensure that 2021 Coding Guidelines are effective. You can determine the overall medical-decision-making level of a patient by reviewing and changing the calculated medication decision making (MDM) levels obtained from MDM elements. Open NextGen® Enterprise EHR. On the Finalize template, expand the Medical Decision - Making Elements panel. The Medical Decision - Making Elements panel displays the automatically-calculated MDM level. Note: Future lab/X-ray orders placed in the current encounter are given credit to calculate the # of each unique test ordered element under MDM table B. Therefore, you must not consider these orders for calculating the # of each unique test reviewed element under MDM table B in future encounters. Note: Only some of the MDM elements in the tables are selected automatically. Review the selected elements and if necessary, modif

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Calculate E&M Codes under 2021 Coding Guidelines

You can calculate the Evaluation and Management (E&M) code under 2021 Coding Guidelines in Evaluation and Management. You can base the Evaluation and Management (E&M) code calculation on the selected Medical Decision Making (MDM) level or total visit time. Open NextGen® Enterprise EHR. For a patient record, open a new encounter. Open the Finalize template. On the Evaluation and Management Coding panel, to calculate the E&M code based on the MDM level, review the prepopulated complexity level or manually select the level of complexity associated with the encounter in the Medical Decision Making section. The Medical Decision Making section displays the MDM level based on the calculated levels in the three tables in the Medical Decision - Making Elements panel. To change the MDM level, change the automatically-calculated MDM levels in the MDM tables, or by making corrections in the encounter chart note. For guidance on using the 2021 Coding Guidelines based on MDM level and time, select t

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Overview of Evaluation and Management Coding

You can calculate and submit the E&M code. You can submit and calculate the Evaluation and Management (E&M) code from the Finalize template using the 95, 97, 2021 Guideline, or 2023 Coding Guidelines update based on the Practice Configuration template settings. The available E&M codes vary by specialty and visit type. If you do not want to charge a patient encounter, you can select the No Charge Visit check box in the Evaluation and Management Coding panel to submit a no-charge code. The No Charge Visit procedure group check box is configured by default. The No Charge Visit check box is enabled only if the no charge SIM code is configured to the No Charge Visit procedure group using the Manage Procedure Group and Codes template. For more information, go to NextGen Healthcare Success Community, and download the latest Manage Procedure Groups and Codes Practice Template forNextGen®Adaptive Content Engine. The 95 and 97 Coding Guidelines use the following E&M code calculation criteria: Hi

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Submit E&M Codes under 2021 Coding Guidelines on the FTS Finalize Template

Before you begin To submit an E&M code, you must have selected an assessment in the Today’s Assessments panel. For more information on assessments, go to NextGen Healthcare Success Community and download the latest Getting Started User Guide forNextGen®Adaptive Content Engine. Open the Finalize template and expand the Evaluation and Management Coding panel. Evaluation and Management Coding To use a calculated E&M code, review and select the MDM level or enter the total time. For more details, see Calculate an E&M Code under 2021 Coding Guidelines on the FTS Finalize Template. The Medical Decision Making section displays the prepopulated MDM level based on the calculated levels in the three tables in the Medical Decision-Making Elements panel. To bypass or override the calculated code, select an E&M code in the code option section at the bottom of the Evaluation and Management Coding panel. Note: Code 99201 cannot be selected. The code expires effective January 1, 2021. Code 99211 Nurse

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Submit E&M Codes under 2021 Coding Guidelines on the Ophthalmology Finalize Template

Before you begin To submit an E&M code, you must have selected a diagnosis. For more information on diagnoses, go to NextGen Healthcare Success Community, and download the latest Getting Started User Guide forNextGen®Adaptive Content Engine.Note: You can override the code from the EM 2021 Guidelines template by selecting another code directly from the Ophthalmology Finalize template. However, this selected code will not fall under the 2021 Coding Guidelines, and the calculated code from the EM 2021 Guidelines template still appears in the Calculated code field. You cannot select eye codes and E&M codes together. If you select an eye code, it overrides the E&M code. Open the Ophthalmology Finalize template and expand the EM Code panel. Enter counseling and educational details and factors. Enter additional visit codes and modifiers. You can add up to two modifiers for a visit code. Note: You cannot enter eye codes and E&M codes together. If you enter an eye code, it overrides the E&M cod

NextGen® Adaptive Content Engine Help Enterprise 8

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.

Determining Medical Decision Making Levels

Recommendations

Review and Modify Medical Decision Making Levels

Calculate E&M Codes under 2021 Coding Guidelines

Overview of Evaluation and Management Coding

Submit E&M Codes under 2021 Coding Guidelines on the FTS Finalize Template

Submit E&M Codes under 2021 Coding Guidelines on the Ophthalmology Finalize Template

Calculate E&M Codes under the 95 or 97 Coding Guidelines

Review and Modify Medical Decision Making Levels

Calculate E&M Codes under 2021 Coding Guidelines

Overview of Evaluation and Management Coding

Submit E&M Codes under 2021 Coding Guidelines on the FTS Finalize Template

Submit E&M Codes under 2021 Coding Guidelines on the Ophthalmology Finalize Template

Calculate E&M Codes under the 95 or 97 Coding Guidelines