decisionhealth Newsletters, Part B News - 2026 Issue 3 (March)
There’s more to high risk than the examples in the E/M guidelines
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Article Overview
This article explains a question-and-answer discussion about evaluation and management (E/M) medical decision-making risk. It focuses on how clinicians and coders should think about the risk table’s examples, the role of clinical judgment, and why the table is not a complete list of all possible moderate- or high-risk situations. The piece is aimed at coders, clinicians, and auditing staff working with E/M documentation and risk assessment.
Why This Topic Matters
Understanding how the E/M risk framework is applied helps support more accurate visit level selection and more consistent documentation. The article is relevant for anyone reviewing whether a patient management decision fits within the guideline examples or should be supported through clinical judgment and note documentation.
What You Will Learn
- How the E/M medical decision-making risk table is intended to be interpreted
- Why guideline examples are not a complete list of all risk scenarios
- The role of clinical judgment in documenting patient management risk
- Why documentation support matters in audit situations
Who Should Read This
- Medical coders
- Coding auditors
- Physicians and other qualified health care professionals
- Radiology documentation staff
- Compliance teams
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