Evaluation and Management Exam Tips

Q: “I’m struggling with E/M. Is there any tips you can offer me so I will feel better about taking the exam?”
A: For this one, I can totally relate to the struggle with E/M because if you listen to our Blitz Review videos, you probably heard me say “I thought E/M was a new M&M candy, when my instructor was teaching me.” That’s how green I was; so you can master this, trust me.
Here are the tips that I helped myself. I knew I had a couple of weeks before the proctor was going to come do the exam and I needed to figure this out. I knew it was an open book exam, my CPT manual. I looked at that and instead of those coding slide rules and all these different ways to learn E/M, what I came away with is this: if you picture your exam booklet, in the margin where that E/M question is, you want to write, think of this little saying: “Locate your HEM in Time.”
What that means is the locate part is where’s the E/M occurring. Meaning, the E/M category and sub-category. So, the office patient new; office patient established; so figure out that category, sub-category. That’s one of the major things; if you can get that down, right there you’re probably going to get 75% of the E/M questions correct because you’re in the right “church” so to speak. We talked about right church wrong pew or vice versa, so want to make sure we get that location correct. It isn’t always about location, it could be about the status but we just say it because it helps us locate your HEM in Time.
The next part of that is the HEM; those are your three key components to E/M - history, exam, medical decision making. Read the little scenario that they give you in the exam. Normally, I would say 80% of the time they give it to you. They tell you what the history level is; they tell you what the exam level is; or what the medical decision making level is. Not always, but a majority of the time.
If you have written in your exam booklet “LOC” for locate with a line, you’re filling that in “office new.” Then you write HEM, each one with a line next to it, you’re trying to fill it in. You’re reading the exam question that says “The physician did a problem focused history.” Write problem focused. Or, if you learned our system we distill that one to one letter so we put a “P”. Then, do the same thing with exam, do the same thing with medical decision making.
The last piece of that “Locate your HEM in Time” is ask yourself was time the dominant factor instead of the three key components? If that’s the case you need to figure out what the time is so you can code based on time. That’s a little tip that way. If you always attack every single E/M question with the same formula “Locate your HEM in Time” and you’re just trying to fill-in those blanks, that should help you through the process of elimination with the multiple choice answers; we only have four different E/M codes. You can probably figure it out.
By the way when you look at those four codes, if you skim them first before you even read the scenario, you could probably figure out “Oh, they’re trying to test me on whether or not I know this is a consult versus an office visit.” So, look at what the actual choices are and that will help with your reading the scenario to drill down on what you need to abstract.
Then the other E/M tip I can give you is when it comes to leveling, we have to figure out if it’s 3 of 3 of those key elements or 2 of 3 of those key elements are required. Alicia referred to that in the question that she was answering about medical decision making. This concept of meeting all 3 like a checklist or just 2 of the 3 is very, very critical. So, they’ve given you what the history is and they’ve given you what the exam is, and they’ve given you what the medical decision making is, now you got to plug it in. We call that leveling.
When you plug in those letters or those levels, then you have to stop and say “OK, this is a 3 of 3 situation” if that’s the case you’re going to code to the lowest one because you need to meet or exceed those 3 elements. If you do, then you’re good to go with that code. If you don’t, then that’s not going to be one of your correct answers. But if it’s a 2 of 3 situation, you can drop one of those bullets, if you will. As long as you’re meeting or exceeding two of those three, then you’re good to go.
What I recommend that you do in your E/M section of your CPT manual, write next to every single code whether or not it’s 3 of 3 or 2 of 3. It says it in each description will say “which requires 3 of these 3 key components,” so I handwrite it in, 3 of 3, 2 of 3, so it jumps out at you.