National Alliance of Medical Auditing Specialists
Article Reference Code: NAMAS.03.20.2026
March 20, 2026
Why a Quick, Memorable Pitch Matters
“Hey Doc, you’ve got a packed schedule, patients waiting, and probably zero patience for another hour-long educational session that feels like death by PowerPoint. So, let’s cut to the chase: I can give you the real-deal on E/M coding in 15 minutes.” If you want to give education that they’ll remember and appreciate, try a quick, no-fluff talk you can deliver in a hallway huddle, lunch break, or right before rounds. Think of it as your personal “elevator pitch” upgraded to a coffee break version. It’s fast, it sticks, and it focuses on what actually matters in 2026: getting paid for the brainpower you pour into patient care without inviting an auditor to crash your weekend.
The most reported CPT codes are E/M services. Unless the physicians are Radiologists or Pathologists, they are doing E/M. E/M remains a constant target for payor audits, so helping physicians get it right protects revenue and compliance. The goal? Equip physicians to select the right code based on complexity (MDM) or time, while fostering better documentation habits. In 15 minutes, cover the fundamentals, leaving room for questions and quick practice. Think of it as a “just-in-time” toolkit that doesn’t disrupt workflows.
Key Terms to Define Succinctly
Start by defining the essentials clearly:
- MDM: Assesses the number and complexity of problems addressed, data reviewed/analyzed, and risk of complications.
- Time: Includes all face-to-face and non-face-to-face activities (e.g., reviewing records, counseling) on the encounter day. This seems to be an area where I still physicians not crediting themselves correctly.
I find it helpful to remind them that the old 6-page novel note is history. The system rewards cognitive effort over bloated documentation. No more 14 review-of-systems bullets for a sprain just to justify a level. Most docs already know this from the 2021/2023 shifts, but reiterating it sets a positive tone.
Visual Aid Recommendation
Use a simple one-page handout: An MDM table summarizing levels (straightforward/low/moderate/high) with brief examples, plus time thresholds for office/outpatient visits. Leave it with them—they’ll refer back when charting. In my experience, physician love little tools that are helpful for documentation.
Dive into MDM: The Star Player for Most Visits
MDM is how most visits level out. Explain the two paths (MDM or time), but focus on MDM with specialty-relevant examples to make the light bulb go off.
Problems Addressed (Number and Complexity)
Three buckets—no bullet-counting bingo anymore:
Straightforward: One self-limited or minor problem (e.g., acute cough, simple rash, minor stomach ache). You advise: “Rest, ice, elevate, chicken soup—call if worse.”
Low: 2+ self-limited/minor problems; 1 stable chronic illness (e.g., well-controlled hypertension, stable psoriasis); 1 acute uncomplicated illness/injury (e.g., mild sprain, simple UTI).
Moderate: 1+ chronic illnesses with exacerbation (e.g., hypertension with recent spikes); 2+ stable chronics (e.g., CAD + hyperlipidemia); 1 undiagnosed new problem with uncertain prognosis (e.g., new fatigue possibly anemia/thyroid); 1 acute illness with systemic symptoms (e.g., gastritis with fever, abdominal pain, diarrhea, dehydration); 1 acute complicated injury (e.g., ankle sprain with ligament damage needing brace/PT referral).
High: 1+ chronic illnesses with severe exacerbation (e.g., uncontrolled diabetes risking ketoacidosis); 1 acute/chronic illness/injury posing threat to life/bodily function (e.g., head trauma with altered mental status needing urgent decisions).
Paint pictures with their specialty examples—pull from real notes to show how problems
Data Reviewed and Analyzed
Don’t bog down here—focus on what physicians do most. Data proves your detective work: Count unique sources/tests, hit category thresholds, and document why it mattered (“Reviewed X because Y led to Z decision”). No double-counting the same test. Tie it to problems/risk (e.g., “Data review supported moderate MDM in this asthma exacerbation”).
Examples physicians see often:
Limited: Reviewed 1 external note + ordered 1 lab.
Moderate: Independent interpretation of a test (e.g., you read the X-ray yourself) or discussion with a specialist.
Extensive: Multiple unique sources + interpretation + discussion.
Tell them to keep it simple: “Skip fluff—document relevance.”
Risk of Complications/Morbidity/Mortality
This element is a little easier as it is not point-based like Data. It’s qualitative, based on the highest level of risk from any management decision in the encounter. Go back to the method used with Problem Addressed and step through each one with examples.
Straightforward/Minimal: Rest, OTC advice, chicken soup, ice/elevate.
Low: OTC meds, PT referral, minor procedures with no risk factors.
Moderate: Prescription drug management (starting/stopping/adjusting any med and explain why); minor surgery with patient/procedure risks; major surgery without risks; social determinants limiting treatment.
High: Drug therapy needing intensive toxicity monitoring (e.g., warfarin with INR checks); major surgery with risks; emergency surgery; hospitalization decision.
Use example after example—show their own notes: “Here’s where you undercoded because risk wasn’t documented clearly.” Walk them through the notes pointing out the good, the bad, and the deficient in their documentation. You should be able to walk them through each level of service with examples that are geared to their specialty.
Final Key Takeaways and Support
Wrap with memorable points:
- The note must support the level. Tell the full story. My favorite line to docs: “If you think it, ink it.” No credit for unspoken thoughts.
- MDM or time—pick one per visit, document it explicitly.
Let the physician know that you are there to support them, protect them, and ensure that their documentation is compliant. Be open to their questions; if you don’t have an answer for something, let them know you will research it and get back to them – and do it. This isn’t about shortcuts; it’s empowering busy physicians to grasp essentials quickly, reduce errors, boost accurate reimbursement, and enhance compliance. Deliver it with empathy and real examples. They’ll remember and appreciate it.
