Course Code: REL-RCC-AMA-EMMDM
Hours: 1
Type: Online Course
Content Expiration Date: 12/31/2028
Learning Objectives:
Recall the terms and definitions used to describe the medical decision-making (MDM) component of Evaluation and Management (E/M) services.
Identify the different elements, associated criteria, and descriptions of medical decision making for Evaluation and Management services.
Apply medical decision making guidelines in selecting the MDM level for E/M visits.
Describe the various levels of complexity of medical decision making, the elements that define each level, and the types of problems involved at each level.
Outline:
Section 1: Introduction
About This Course
Learning Objectives
Section 2: Overview
E/M Overview
Evaluation and Management Services
Medical Decision Making
Types of Medical Decision Making
Review
Summary
Section 3: Medical Decision Making Guidelines and Definitions
MDM Element: Number and Complexity of Problems Addressed
Minimal problem
Self-limited or minor problem
Stable, chronic illness
Acute, uncomplicated illness or injury
Acute, uncomplicated illness or injury requiring hospital inpatient or observation level care
Stable, acute illness
Chronic illness with exacerbation, progression, or side effects of treatment
Undiagnosed new problem with uncertain prognosis
Acute illness with systemic symptoms
Acute, complicated injury
Chronic illness with severe exacerbation, progression, or side effects of treatment
Acute or chronic illness or injury that poses a threat to life or bodily function
Documenting Problems and Management Options
Examples
Important Note
MDM Element: Amount and Complexity of Data to Be Reviewed and Analyzed
Analyzed
Test
Unique
Combination of Data Elements
External
External physician or other qualified health care professional
Discussion
Independent historian
Independent interpretation
Appropriate source
Documenting Data Review
Examples
MDM Element: Risk of Complications and/or Morbidity or Mortality of Patient Management
Morbidity
Social determinants of health
Surgery
Drug therapy requiring intensive monitoring for toxicity
Parenteral Controlled Substances
Documenting Risk
Examples
Important Note
Levels of MDM Criteria
Review
Summary
Section 4: Determining the Level of MDM
Determine the Extent of MDM
E/M Example 1:
E/M Example 2:
E/M Example 3:
E/M Example 4:
Coding Application: Selecting the Level of MDM
Clinical Scenario 1
Clinical Scenario 2
Clinical Scenario 3
Clinical Scenario 4
Clinical Scenario 5
Summary
Section 5: Conclusion
Course Summary
Course Information
Course Contributors
Resources
References
Writer: Sarah A. Serling, CCS, CPC, COC, CRC, CCS-P, CEMC, CPC-I, ICD-10-CM/PCS Trainer
Sarah is a Subject Matter Expert/Writer for Relias's Revenue Cycle and Coding online education. Sarah is credentialed by AHIMA as a Certified Coding Specialist (CCS) and Certified Coding Specialist Physician-based (CCS-P), as well as an approved ICD-10-CM/PCS Trainer. She is also credentialed by AAPC as a Certified Professional Coding Instructor (CPC-I), a certified professional coder (CPC), a certified outpatient hospital coder (COC), and a Certified Risk Adjustment Coder (CRC), with specialty certification in Evaluation and Management Services (CEMC). Sarah extensive experience in both professional and facility ICD-10-CM/PCS, CPT, and HCPCS coding, education, auditing, and revenue cycle management. She has clinical experience as an Emergency Medical Technician (EMT) and Medical Assistant (MA) and has served as Director of Physician Billing and Reimbursement for a regional health system, Manager of Coding and Compliance for a hospital and cancer center, and Business Manager of Physician Practices at a teaching hospital, as well as a coding auditor and consultant. Sarah has also authored several coding textbooks, and other instructional resources.
Subject Matter Expert: Ronntriesse Cope-Prevatt, CPC, CRC
Ronntriesse Cope-Prevatt, CPC, CRC
Ronnie is a certified coder with over ten years of experience in profee coding, billing, and auditing. She also has a strong background in HCCs, patient administration, working claims edits, and denials management. Ronnie's coding expertise is in the areas of Orthopedics, Neurology, Pain Management, Interventional Cardiology, Gynecology, Urology, General Surgery, Gastroenterology, and Primary Care.
Target Audience:
The target audience for this course is: Healthcare Billing and Coding; in the following settings: Hospitals: Acute.
Relias Learning will be transparent in disclosing if any commercial support, sponsorship or co-providership is present prior to the learner completing the course.
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All courses offered by Relias Learning, LLC are developed from a foundation of diversity, inclusiveness, and a multicultural perspective. Knowledge, values and awareness related to cultural competency are infused throughout the course content.
To earn continuing education credit for this course you must achieve a passing score of 80% on the post-test and complete the course evaluation.
Course Delivery Method and Format
Asynchronous Distance Learning with interactivity which includes quizzes with questions/answers, and posttests.