Can We Automate E&M Coding in EMR Systems?

Another thought-provoking article by my friend John – here.
E&M Coding guidelines are so old. They’re from 1995 and 1997. If we look at what the guidelines say, it starts with the basics – whether the patient encounter was Brief (1-3 elements)or Extended (4 or more elements). This is just for the History of the Present illness, where HPI Elements include: location, quality, severity, during, timing, context, modifying factors, and associated signs/symptoms.

This is the easy part.

Then you look into ‘complexity’, data reviewed, and ‘risk of complications’.

We are not at a point where ‘systems’ can evaluate risk and complexity. Also, as doctors frequently tell me, it may not be a complex case or may not be that high of a risk, but if the patient is talkative, and I spend more than 30 minutes with the patient, my level of coding may jump up.

Secondly and more importantly, these guidelines may be rendered totally obsolete if healthcare reform progresses where reimbursements would be tied to a ‘continuum of care’ rather than pure ‘episodic’.

Just additional food for thought.

Author: Chandresh Shah

Chandresh Shah specializes in Healthcare IT and Medical Billing. He knows the market inside out; what works, what doesn’t. He advises and works with small business owners.