It can be difficult to translate the E/M rules into patient scenarios that ring true and are applicable to every day clinical encounters. The guidelines seem great in theory, but how does a clinician, coder, or auditor apply them to select the correct level of service?

Here are examples based on MDM, not time, that represent common visits in medical practices and health centers.

99202/99212: The patient came in for this?

Patient presents at the urging of a neighbor for a 1 cm by 1 cm red rash on his arm. Assessment: “Red area on arm. No concerns. Use moisturizing cream.”

• Number and Complexity of Problems Addressed–Straightforward
• Amount and/or Complexity of Data to be Reviewed and Analyzed–None
• Risk of Complications and/or Morbidity or Mortality of Patient Management—Minimal

99202/99212: Follow up from an acute uncomplicated illness

7 day follow up from an upper respiratory condition with wheezing. At the visit 7 days prior, the patient was given a nebulizer treatment and the practitioner suggested OTC meds. The practitioner did two point of care tests, both negative.

At this follow up visit, the patient condition is resolved. There is no testing.  The patient no longer is taking the OTC medication.

• Number and Complexity of Problems Addressed—Low: a stable acute illness
• Amount and/or Complexity of Data to be Reviewed and Analyzed—None
• Risk of Complications and/or Morbidity or Mortality of Patient Management—Minimal

99203/99213: Acute, uncomplicated condition

Patient complains of heartburn of 2-week duration, mild severity. Assessment: GERD, OTC medications.

• Number and Complexity of Problems Addressed—Low, acute uncomplicated illness
• Amount and/or Complexity of Data to be Reviewed and Analyzed–None
• Risk of Complications and/or Morbidity or Mortality of Patient Management—Low OTC medication