Quick answer

Choose a scribe that explains its E/M suggestion using the three MDM pillars—Problems, Data, Risk—and keeps psychotherapy add-on 90833 separate with its own minutes/modality/justification.

What “good” MDM support looks like (checklist)

1. Explicit MDM pillars — Problems addressed (severity/chronicity), Data reviewed/ordered, Risk of management; each with concrete bullets from the visit.

2. Transparent code rationale — A single line like: “99214 supported due to 2+ chronic problems with exacerbation; rx management with monitoring; med labs ordered.”

3. Source linking — Each MDM bullet traces back to text in the note (e.g., assessment/plan, meds, results).

4. Psychotherapy separation — 90833 shown outside the E/M logic with minutes, modality, and clinical justification.

5. Medication management detail — Changes, titrations, side-effects, adherence, and monitoring (e.g., labs, AIMS) surfaced in MDM-Risk.

6. Continuity signals — Prior response to meds/therapy and treatment-plan goals pull forward to support medical necessity.

7. Audit-friendly export — The MDM explanation prints with the note and is editable pre-sign.
   
   

10-minute evaluation script (copy/paste)

1. Record a 7–10 min psychiatric follow-up (med review + brief therapy).

2. Generate the draft and scroll to MDM: verify Problems/Data/Risk are each populated with specifics from today’s visit.

3. Read the E/M suggestion line (e.g., 99214) and confirm the reasoning aligns with the visit content.

4. Check psychotherapy: 90833 shows minutes, modality, and a specific justification—separate from MDM.

5. Edit one item (e.g., remove a lab order) and confirm the MDM recommendation updates.

6. Export a PDF and confirm the MDM explanation and psychotherapy add-on appear for audit.
   
   

Example structure — Psychiatric Follow-Up with MDM

• Reason / Interval History (symptoms, function, stressors)

• Medications (changes, adherence, side-effects; monitoring)

• Psychotherapy Provided (minutes, modality, focus)

• Mental Status Exam

• Assessment & Plan (dx, changes, orders, safety plan)

• MDM (explained)

  • Problems: e.g., “MDD—partial response; GAD—worsened sleep.”

  • Data: e.g., “Reviewed PHQ-9; ordered TSH; reviewed labs from PCP.”

  • Risk: e.g., “Medication adjustment with monitoring; suicide risk low; counseling provided.”

  • Suggested E/M: e.g., 99214 with one-line rationale

• 90833 Psychotherapy Add-On (minutes, modality, justification)
  
  

FAQ

Is time-based coding better than MDM for psych?
Both are allowed. MDM often reflects psychiatric complexity more accurately when meds are adjusted or data is reviewed.

Should psychotherapy minutes affect the E/M level?
No. Keep 90833 separate; E/M should be driven by MDM (problems, data, risk).

Can groups standardize MDM phrasing?
Yes—set org defaults for MDM bullets and require an editable rationale line.

Next steps

• Run the 10-minute evaluation with your shortlist.

• Add a med-change and a stable med scenario to see if recommendations adjust properly.

• Confirm the MDM explanation exports with the note.