NextGen Knowledge Center

Finalizing E&M Coding for an Encounter

Because the E&M Guidelines are not always clearly defined and comments cannot be included in the E&M calculations in NextGen® Adaptive Content Engine, the overall E&M level is only suggested. As the physician or provider performing the encounter, you must review and confirm the E&M code before you submit it for billing.

The Finalize template calculates the E&M code based on the selected E&M coding guidelines on the Practice Configuration template.

Under the 95 and 97 Coding Guidelines, the Finalize template offers the following functionality:

  • The template totals the E&M components documented in the encounter.
  • When you select Calculate Code, several stored procedures calculate the components. The application then suggests an E&M level for the encounter. You can override the suggested E&M level code by selecting an E&M codes listed on the template. You can use the second and third visit code fields to enter additional E&M codes from a Service Category list or from lists you access through the Additional E&M Code, Additional Behavioral Health Codes, and Medicare Preventive Codes links.
  • You can view E&M calculation totals for each component of the history level and exam in the following panels based on the coding guidelines selected on the Practice Configuration template:
    • History Details
    • 97 Multi System Physical Exam Details
    • 97 Single System Physical Exam Details
    • 95 Physical Exam Details
  • View MDM Guidelines and View Risk Table links open information on the level of complexity involved in Medical Decision Making (MDM) and the level of risk.
  • The Web button on the Finalize template opens one of the following Centers for Medicare and Medicaid Services (CMS) documents based on the coding guidelines selected on the Practice Configuration template:
    • 1997 Documentation Guidelines for Evaluation and Management Services
    • 1995 Documentation Guidelines for Evaluation and Management Services
Under the 2021 Coding Guidelines, the Finalize template offers the following functionality:
  • The template calculates the E&M codes 99202 to 99205 and 99212 to 99215 based on the selected MDM level or total time spent on patient care and documentation for the visit. You can overwrite the suggested E&M level code by selecting an E&M code listed on the template. You can use the second and third visit code fields to enter additional E&M codes. You can add codes from a Service Category list or from lists you access through the Additional E&M Code, Additional Behavioral Health Codes, and Medicare Preventive Codes links.
  • The Medical Decision Making section in the Evaluation and Management Coding panel displays the MDM level based on the calculated levels from the three tables in the Medical Decision-Making Elements panel. To change the pre populated MDM level, change the calculated MDM levels in the Medical Decision-Making Elements panel.
  • The View MDM Guidelines button opens a table describing the elements of MDM for each available E&M code and level and their risks of complications and morbidity or mortality of patient management.
  • The Web button opens the American Medical Association (AMA) guidelines entitled “CPT® Evaluation and Management.”

For more information about the Finalize template, go to NextGen Healthcare Success Community, and download the latest Getting Started User Guide for NextGen® Adaptive Content Engine.