Don’t Let Assumptions Dictate Your Evaluation and Management (E/M) Coding

E/M Coding for Chiropractors Made Simple: Pediatric Patients and Beyond

Hot Topics from the KMC University HelpDesk

If you choose an Evaluation and Management (E/M) code on autopilot, you’re not alone. Many chiropractors assume a patient’s age, or a “simple” complaint, automatically means a lower code. That habit often leads to under-coding, especially for new patients. Example: defaulting to 99202 for a 12-year-old “because kids aren’t complex.” In reality, that mindset leaves money on the table and fails to reflect the work you actually performed.

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The fix is simple: base your E/M code on Medical Decision Making (MDM) or Total Time, not assumptions. Since the 2021 update, office/outpatient E/M codes 99202-99215 rely on one of those two factors.

Choose by Medical Decision Making (MDM)

For most visits, MDM is the best fit. It’s not about age; it’s about the complexity of your thinking. MDM evaluates three elements:

Number and complexity of problems addressed

• Are you managing more than one problem? Is a pre-existing condition influencing today’s complaint?

Amount/complexity of data reviewed and analyzed

• Did you review prior records, order imaging, or consult another provider?

Risk of complications and/or morbidity of patient management

• What’s the risk tied to your plan today?

Example: A new pediatric patient with postural strain, a possible scoliosis pattern, and care coordination with the pediatrician may easily meet the requirements for a higher-level code. Age doesn’t decide complexity – your decision making does.

Or Choose by Total Time

You can also code by total provider time on the date of the encounter. This includes more than face-to-face minutes: reviewing records, prepping for the visit, counseling the patient/parent, ordering tests, and documenting your note all count.

Common thresholds for new patient codes:

• 99202: 15 minutes (met or exceeded)
• 99203: 30 minutes (met or exceeded)
• 99204: 45 minutes (met or exceeded)

Example: A visit that includes a detailed parent history, posture counseling, and thorough documentation can easily reach 30 minutes, supporting 99203, even for a 12-year-old.

How to Get It Right—Every Time

• Document intentionally. Capture the thinking behind your diagnosis and plan.
• Pick one method: use MDM or Time – whichever accurately reflects the work.
• Avoid note-bloat. Don’t stuff the note to chase a higher code.
• Stop under-coding. Don’t let age or assumptions lower your level automatically.

The Bottom Line

Before you submit the claim, ask two quick questions:

1. How much total time did I spend today?
2. What was the true complexity of my decision making?

When you document clearly and choose the level based on E/M coding for chiropractors (MDM or Time), your billing stays accurate, compliant, and aligned with the value you deliver—no matter the patient’s age.

Dr. Erin Stubblefield graduated from Palmer College of Chiropractic in Davenport, IA in 2006. After practicing privately, she transitioned to Chiropractic education for 13 years before joining KMC University as a Specialist in 2024. Currently, Dr. Stubblefield is the owner of Sunflower Consulting, LLC, a healthcare consulting and practice coaching group. Dr. Stubblefield partners with KMC to provide accurate, current, and compliant information. For further information, you can reach her at drerin@kmcuniversity.com.