What is the primary factor for determining the level of E&M code?

What is the primary factor for determining the level of E&M code?

• A. Medical-decision making
• B. The patient’s insurance plan
• C. The number of prior visits
• D. The clinician’s years of experience

Answer: (A)

Medical-decision making is the main factor used to determine the level of an E&M code. It reflects how complex the clinician’s decisions are, including how many problems are addressed, the amount and complexity of data reviewed or ordered (such as tests or records), and the risk of complications or mortality if the condition isn’t treated or if the chosen management differs. Higher complexity in decision making generally leads to a higher code level. The patient’s insurance plan, the number of prior visits, or the clinician’s years of experience do not determine the level. In some scenarios, time spent with the patient can drive the level if time is the documented basis, but standard practice centers on the complexity of medical decision making.

Medical-decision making is the main factor used to determine the level of an E&M code. It reflects how complex the clinician’s decisions are, including how many problems are addressed, the amount and complexity of data reviewed or ordered (such as tests or records), and the risk of complications or mortality if the condition isn’t treated or if the chosen management differs. Higher complexity in decision making generally leads to a higher code level. The patient’s insurance plan, the number of prior visits, or the clinician’s years of experience do not determine the level. In some scenarios, time spent with the patient can drive the level if time is the documented basis, but standard practice centers on the complexity of medical decision making.