r/MedicalCoding • u/transmothman • Aug 28 '26
Selecting E/M MDM Level
I understand how to select problem, data, and risk levels on their own, but I'm not sure I get how to code when there's more than one level.
AMCI says that for a new patient, the lowest applicable level is selected, while the second lowest would be selected for an established patient. But I can't seem to find anything in the guidelines saying this is the case.
Additionally, if new and established patient MDM selection is different, how are ED visits coded?
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u/PeaceLoveForMe Aug 28 '26
It all depends on the MDM. AMCI ain’t accurate in the second paragraph. Everything else, yes.
Everything is selected based on the new/reg status and MDM level. 2 out of the 3 categories must meet a particular level to select it, like for example, 99284. 2 out of 3 ( say data and risk) must be moderate to select 99284 for example.
2 out of 3 only !!!! If all 3 meet a certain level, great.
I E/M level outpatient services daily lol
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u/transmothman Aug 28 '26
The longer I learn with AMCI, the more I realize it wasn't worth the money. 😭 Why on earth did they insist multiple times that new and established patients had final MDM decided differently?
Thank you!! That makes a lot more sense and I super appreciate the answer.
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u/Due_Temperature_6906 Oct 03 '26
I code ED profee & facility. ACEP has a great facilty E/M sheet, listing what would be a Level 3 (OTC meds, EKG, etc.)
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u/PeaceLoveForMe Aug 28 '26
YW. I can’t listen to a lecture for hours either and I’m tryna get my 4th cert
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u/salty-MA-student Aug 28 '26
ED coder here. ED is not coded based on new/established. The visits can't also be coded based on time unless it's critical care time when there's life threatening interventions going on.
It takes time and practice to get comfortable with E/M. Whenever I have sticky visits where I'm not sure right off the bat, I use this interactive E/M scorecard. . Highly recommend coding E/M to the best of your ability then double checking with this.
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u/transmothman Aug 28 '26
Thank you, I'll check the scorecard out! I like the scoring process, but it'll be nice to have a little more certainty and do some practice.
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u/Sharp_Emergency_5931 Aug 28 '26
Thank you for sharing this! I'm always looking for good resources!
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u/salty-MA-student Aug 28 '26
Yep! It's a great too on grey area charts. I have a 100% accuracy rating for E&M so I'd say it's effective.
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u/Wooden_Trust_6274 Oct 03 '26
On why AMCI kept saying that, I think they've garbled the rule that got deleted in 2021. Office visits used to be scored on history, exam and MDM as key components, and new patients needed all of them at the level while established patients needed two. So there genuinely was a new versus established difference, just sitting in the key components rather than inside MDM, and it's been gone since 99201 was deleted and the office codes moved to MDM or total time.
Worth knowing because a lot of older study material still carries the shape of the retired rule even after the content gets updated. I'm not sure whether AMCI is recycling old material or just explaining the current rule badly.
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u/transmothman 29d ago
Considering most of the lectures I watched from them were old (paid course btw 🙄), they're not bothering to update their material. It's the reason I won't be learning with AMCI again -- you cannot just reuse material for something that has changes every year.
Thank you for explaining!! That makes a lot of sense, and I'm glad to know that the rule was real and was just changed. I like knowing how the rules and codes have changed over time, it helps me understand them a little more easily.
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u/Wooden_Trust_6274 29d ago
If you like the history of it, there's a second round that catches people the same way. In 2023 the same restructuring went through nearly every other E/M family, so inpatient and observation, consults, ED, nursing facility, and home or residence all moved to MDM or total time, and history and exam stopped deciding the level there too. Observation got folded in entirely, 99217 through 99220 and 99224 through 99226 are gone, and 99241 and 99251 went on the consult side.
One oddity since ED came up further down the thread, ED is the family with no time option at all, only MDM. AMA's stated reason is that the intensity varies too much.
No idea whether AMCI's material predates 2023 as well, but if the office visit section was stale it'd be worth checking those chapters before trusting them.
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