E/M Visit Calculator
Office E/M codes are chosen by total time or by medical decision making — not by history and exam bullets anymore. Enter your time, or grade the three MDM elements, and get the code with the reasoning shown.
Since 2021, office and outpatient E/M codes 99202–99215 are chosen by medical decision making (MDM) or by total time on the encounter date — your choice, whichever supports the higher level honestly. Pick a method below and get the code the rules point to, with the reasoning shown.
Find the E/M code
How the two methods work
Time counts all time the billing provider personally spends on the encounter date: reviewing records before the visit, the face-to-face visit itself, documenting, coordinating care and communicating with other professionals the same day. It does not include clinical staff time or time spent on separately reported procedures. MDM grades three elements — problems addressed, data reviewed, and risk — and the overall level is set by two of the three (the middle value). The history and exam no longer drive the level, though a medically appropriate history and exam should still be performed and documented.
Reading your result
- Time and MDM disagree — that is normal. Bill the method that reflects the encounter and is fully documented; never average the two.
- Consistently landing on 99213 — check whether data review (outside records, independent interpretation, discussion with another provider) is being documented; it is the element most often under-recorded.
- 99211 — not selectable by time or MDM. It covers an established-patient visit that may not require a physician or QHP, typically staff-provided services.
E/M level errors are among the most common audit findings in outpatient billing. If your practice sees a pattern of downcoded or denied visits, our medical coding team can review a sample of encounters against the documentation.
Frequently asked questions
Can I choose between time and MDM for the same visit?
Yes. For office and outpatient visits 99202–99215 you may select the level using whichever method — total time on the encounter date, or MDM — better reflects the encounter, provided that method is fully documented. You cannot combine partial credit from both.
What time counts toward an E/M visit?
All time the billing provider personally spends on the encounter date on that patient: pre-visit record review, the visit itself, same-day documentation, care coordination and communication with other professionals. Time spent performing a separately reported procedure, and clinical staff time, do not count.
Why is 99211 not in this calculator?
99211 has no time range and no MDM requirement. It describes an established-patient visit that may not require the presence of a physician or other qualified health care professional — typically a staff-provided service such as a blood pressure check. It is therefore never the output of a time or MDM calculation.