Auditing Office E&M Services – Is it a Level 3 or Level 4?

In 2021, significant changes were made in CPT for the code set Office and Other Outpatient Services.  In addition to changing the requirements for the history and physical exam, level of service is now determined exclusively based on a new Elements of Medical Decision-Making Table or on the total time of the visit (time spent on allowed activities). 

Since the change occurred, many providers struggle to determine if a visit has Low or Moderate Medical Decision Making (MDM), which correspond to a level three or level four visit. This webinar will offer easy to follow examples of the subtle differences that can occur between the two levels.  

Webinar Objectives

The key to discerning the difference between moderate and low medical decision making is understanding the individual components of the table of the Elements of Medical Decision Making. 

There are components of the table that the AMA gave great information on.  Unfortunately, other parts are not as well defined.  Neither by CPT in their Guidelines nor by AMA in its release of information prior to the release of the 2021 CPT books. 

In order to distinguish the difference between a level 3 and level 4 office visit, one needs to understand each of items in the Elements of Medical Decision Making. 

Webinar Highlights

• Overview of AMA’s document on the changes to Office & Other Outpatient Services in 2021
• Overview of the table of Elements of Medical Decision Making
• Requirements of moderate and low medical decision making
• Practical application of the requirements of MDM
• Sample scenarios

Who Should Attend

Coders, billers, auditors, office managers, practice managers