CPT E/M Code Calculator

CPT E/M Code Calculator

For Educational & Personal Use Only | Based on AMA Guidelines | Review our disclaimer

How to Use This Calculator

• Step 1: Select patient type (New or Established)
• Step 2 (Optional): Select preventive well visit age category if applicable
• Step 3: Select problems addressed, data reviewed, and risk factors
• Step 4 (Optional): Use the auto-running stopwatch to track encounter time, or manually enter time. Click "Use Stopwatch Time" to transfer stopwatch time to the manual input field.
• Result: The calculator automatically determines the appropriate E/M code using the 2 of 3 MDM rule

Note: If both a well visit and E/M code are generated, the E/M code should be billed with modifier -25. Time-based coding is shown as an alternative when applicable - use whichever yields the higher level code. The stopwatch automatically starts when you load the page and continues running until paused.

Do not enter real patient information. This calculator is for personal and educational purposes only. For actual billing decisions, use your institution's approved systems and consult with certified medical coders.

Number and Complexity of Problems Addressed

Select all that apply for this encounter

Minimal (Straightforward)

1 self-limited or minor problem

Low

2 or more self-limited or minor problems

1 stable chronic illness

1 acute, uncomplicated illness or injury

Moderate

1 or more chronic illnesses with exacerbation, progression, or side effects of treatment

2 or more stable chronic illnesses

1 undiagnosed new problem with uncertain prognosis

1 acute illness with systemic symptoms

1 acute complicated injury

High

1 or more chronic illnesses with severe exacerbation, progression, or side effects of treatment

1 acute or chronic illness or injury that poses a threat to life or bodily function

Amount and/or Complexity of Data to be Reviewed and Analyzed

Select all that apply (each unique test, order, or document counts as 1)

Minimal or None

Minimal or none

Category 1: Tests, Documents, or Independent Historian(s)

Review of prior external note(s) from each unique source

Number of unique sources:

Review of the result(s) of each unique test

Number of unique tests:

Ordering of each unique test

Number of unique tests:

Assessment requiring an independent historian(s)

Category 2: Independent Interpretation of Tests

Independent interpretation of a test performed by another physician/other qualified health care professional (not separately reported)

Category 3: Discussion of Management or Test Interpretation

Discussion of management or test interpretation with external physician/other qualified health care professional/appropriate source (not separately reported)

Risk of Complications and/or Morbidity or Mortality of Patient Management

Select the highest applicable risk level

Minimal Risk

Minimal risk of morbidity from additional diagnostic testing or treatment

Low Risk

Low risk of morbidity from additional diagnostic testing or treatment

Moderate Risk

Prescription drug management

Decision regarding minor surgery with identified patient or procedure risk factors

Decision regarding elective major surgery without identified patient or procedure risk factors

Diagnosis or treatment significantly limited by social determinants of health

High Risk

Drug therapy requiring intensive monitoring for toxicity

Decision regarding elective major surgery with identified patient or procedure risk factors

Decision regarding emergency major surgery

Decision regarding hospitalization

Decision not to resuscitate or to de-escalate care because of poor prognosis

⏱ Time-Based Coding (Optional Alternative)

00:00

Running

Manual Time Entry (minutes)

Preventive Well Visit (Optional)

Calculated E/M Code

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