Clinicians

Coding at sign-off

Two E/M levels, the reasoning behind the recommendation, and why the system deliberately suggests the lower one.

9 min · Clinicians · lesson v1

Coding appears twice. In Assessment & Plan the Coding tab is a preview — Suggested only — preview. Attest at sign-off; nothing is billed automatically. The decisions happen at sign-off.

The card

  1. At sign-off: Draft coding (attestation required — drives automatic billing).

    The line under the heading is worth reading once, properly: Clinician attests codes. On Sign & Finalize the system will capture charges, generate a correct X12 837P (professional claim format), and submit via clearinghouse abstraction to the patient's payer.

    The table is Attest, Type, Code, Description, Fee $ (editable), Source, Documentation.

    Screenshot pending capture

Fees prefill from Admin → Billing configuration → Fee schedule where the code has an active entry. The amount shown is what gets billed, and you can edit it before finalizing.

The E/M row

  1. The E/M row is a choice between exactly two codes, and the recommended one is marked with :

    CodeDescriptionTime
    99203Office visit, new patient — low MDM30–44 minutes total on the date of the encounter
    99204Office visit, new patient — moderate MDM45–59 minutes
    99213Office visit, established patient — low MDM20–29 minutes
    99214Office visit, established patient — moderate MDM30–39 minutes

    You see the new pair or the established pair, never all four.

    Screenshot pending capture

Under the description, two lines do the explaining.

The class line says which pair you're being shown and why — for example Booked as a follow-up; last visit 2026-03-14. Beside it is a link to switch: Use new-patient codes instead / Use follow-up codes instead.

The basis line is at its most useful when the booking was wrong:

Booked as a follow-up, but no visit with this practice in the last 3 years is on file — by the CMS 3-year rule this would be a NEW patient.

Booked as a new-patient visit, but the chart shows a visit on 2025-11-02 — within 3 years, which would make this established.

The rationale line, prefixed , is why this level:

Moderate MDM: 2 of 3 elements met — prescription drug management; 2 stable chronic illnesses addressed.

Low MDM: only the risk element reaches moderate (prescription drug management) — 2 of 3 are required for level 4. Raise the level if your note supports it.

Why it suggests the lower level

The recommendation defaults down on purpose. The reasoning, from the code that produces it: an under-coded draft is corrected in ten seconds at sign-off; an over-coded one is a compliance problem.

So the system is not trying to guess your billing — it is trying to be wrong in the safe direction, and to hand you the reasoning so you can correct it. Which means you should expect to raise the level sometimes, and that doing so is normal.

What each level requires expands into the actual criteria: level is set by medical decision making — 2 of the 3 elements must meet or exceed it — or by total time on the date of the encounter, with the Problems, Data and Risk definitions written out.

Attesting

Tick Attest against each code you accept. If you finalize with none attested you get a blocking message: Please attest at least one code (check the boxes in Draft coding) before finalizing.

What usually goes wrong

Accepting the ✦ because it is marked. It is the safe default, not an assessment of your documentation. Read the rationale and decide.

Missing a wrong new-versus-established call. It changes the code pair entirely, and the booking is not always right. The basis line tells you when to look.

Editing a fee without knowing the schedule. The amount shown is what gets billed. If it looks wrong, check Admin → Billing configuration rather than typing over it.

Treating attestation as paperwork. It generates a claim.

Check yourself

No score, no account — just make sure you can answer these before you move on.

  1. The system recommends 99213 but your documentation supports 99214. Are you supposed to argue with it?

    Show the answer

    Yes — that is the design. The rationale even invites it: Low MDM: … — 2 of 3 are required for level 4. Raise the level if your note supports it. It defaults low on purpose, because an under-coded draft is corrected in seconds and an over-coded one is a compliance problem.

  2. The visit was booked as a follow-up, but the basis line says no visit in three years. What now?

    Show the answer

    Switch it. The line reads Booked as a follow-up, but no visit with this practice in the last 3 years is on file — by the CMS 3-year rule this would be a NEW patient. Use Use new-patient codes instead, which swaps the pair to 99203/99204.

  3. What actually happens when you tick an attestation box and finalize?

    Show the answer

    The card names it — drives automatic billing. On Sign & finalize the system captures charges from the codes you attested, generates an X12 837P professional claim, and submits it via the clearinghouse abstraction. Attesting is a billing action, not a formality.