The E/M Calculator in Codify helps you work through the key elements used to determine an Evaluation and Management level of service.

It guides you through encounter information, Medical Decision Making, time-based coding, critical care services, and the final calculated code level.

How to Access the E/M Calculator

1. Open the Coding Tools tab in Codify.
2. Select E/M Calculator.

Across the top of the calculator, you’ll see five main sections:

• Encounter Data
• Medical Decision Making
• Time-Based Coding
• Critical Care Services
• Final Code Level

Step 1: Enter Encounter Data

Start on the Encounter Data tab.

Enter the Date of Service. Once the date is entered, additional options will appear.

Select the appropriate Type of Service.

For example:

Office/Outpatient Visit

Next, select the appropriate Type of Visit.

For example:

New Patient

Once the encounter information is complete, select Save.

You can also select Clear at any time to remove the information entered and start again.

Step 2: Complete Medical Decision Making

Select the Medical Decision Making tab.

The Medical Decision Making section is divided into three components:

• Number and Complexity of Problems Addressed
• Amount and/or Complexity of Data to be Reviewed and Analyzed
• Risk of Complications and/or Morbidity or Mortality of Patient Management

Number and Complexity of Problems Addressed

Review the conditions addressed during the encounter and select the option or options that best match the documentation.

Selections range from self-limited or minor problems to chronic or acute illnesses that may pose a threat to life or bodily function.

Choose the options that reflect the problems addressed during the encounter.

Amount and/or Complexity of Data to be Reviewed and Analyzed

Enter the number of unique tests, orders, or documents reviewed or analyzed.

This can include:

• Prior external notes
• Test results reviewed
• Tests ordered

You can also select additional data elements when applicable, including:

• Assessment requiring an independent historian
• Independent interpretation of a test
• Discussion of management or test interpretation with an external physician or other qualified health care professional

The calculator uses the information entered to determine the applicable data level.

Risk of Complications and/or Morbidity or Mortality of Patient Management

Use the risk table as a guide and select the factor or factors that best match the documented patient management.

Risk levels are organized as:

• Minimal
• Low
• Moderate
• High

For example, prescription drug management may fall under Moderate risk.

Examples of High risk include drug therapy requiring intensive monitoring for toxicity or a decision regarding hospitalization.

The overall risk level is based on the highest applicable selection.

As you complete the Medical Decision Making section, the calculator displays the resulting MDM complexity.

For example, the calculated result may display as:

High Complexity

Step 3: Use Time-Based Coding

If the encounter is being coded based on time, select the Time-Based Coding tab.

Select the appropriate:

• Type of Service
• Type of Visit

The calculator will then ask whether the documentation includes the total time on the date of service.

Time-based coding is available when this criterion is selected as Yes.

Complete the applicable time information based on the documentation.

Step 4: Review Critical Care Services

If critical care applies to the encounter, select the Critical Care Services tab and complete the applicable information.

If critical care does not apply, continue to the Final Code Level section.

Step 5: Review the Final Code Level

After completing the applicable sections, select Final Code Level.

This page summarizes the information entered throughout the calculator.

The results may include:

• Type of Service
• Type of Visit
• Number and Complexity of Problems Addressed
• Amount and/or Complexity of Data Reviewed and Analyzed
• Risk of Complications and/or Morbidity or Mortality of Patient Management
• Medical Decision Making
• Time information, when applicable

For example, if the Number and Complexity of Problems Addressed is High and the Risk of Complications and/or Morbidity or Mortality of Patient Management is High, the resulting Medical Decision Making level may display as High Complexity.

At the bottom of the page, you’ll also find the Reviewer’s Code and the corresponding description when available with your subscription.

You can download or print the Final Code Level for reference.

Summary

The E/M Calculator brings the key elements used to evaluate an E/M service into one guided workflow.

By moving through Encounter Data, Medical Decision Making, Time-Based Coding, Critical Care Services, and Final Code Level, you can review the information documented for the encounter and see the resulting calculated level in one place.