Article Reference Code: NAMAS 10.10.2025
Stop Teaching the Grid. Start Teaching the Why: Mentoring in MDM Auditing
Written by: Shannon DeConda
Auditing can feel like trying to solve a puzzle where the pieces keep changing shape. When we work with other coders and auditors who are struggling with E/M it’s not about finding the right puzzle piece for them. It’s about helping them discover the right pieces on their own as you help create clarity by building their confidence, transforming their understanding, which translates into their own real-world on the job impact.
Recently, I had the opportunity to work with a newer auditor who was really struggling with MDM. They could quote the guidelines but putting into practical application left them second-guessing. We had to Stop – Pivot- and readjust our focus. We sat down and started reviewing each encounter with not only the MDM grid, but also with five additional steps to allow her to really reframe the encounter in a different light.
⇒ Step 1: Step Back and Define “Why”
Before we try to start checking any box or analyzing any visit, start with the most basic question. Why did this patient walk into the room to see the provider today?
Period.
Not how complex the issue was.
Not what the risk might be.
Not what was ordered, reviewed, or discussed.
Just why.
Start with that simple foundation—and build from there.
When mentoring someone through MDM auditing, this shift reframes the entire encounter. It turns the visit from a coding puzzle into understanding the patient’s story. From there, you can layer the complexity, risk, and data, but you need the why to understand the what.
*Mentor Tip* Ask your mentee to summarize the visit in one sentence: “This patient came in because…” That one sentence can reveal clarity, or confusion, and that’s where real education begins.
⇒ Step 2: Reframe the MDM Grid as a Storytelling Tool
Many auditors get stuck when they treat the MDM table like a checklist, assuming each column must be fully addressed. That’s not the case. These are guidelines, not rigid rules, not mandatory criteria, and definitely not a scoring system. The goal isn’t to check every box to understand the provider’s thought process. Guide mentees through these three core questions:
- What work was performed by the provider? (Data reviewed, tests ordered, consults requested)
- What problems were discussed with the patient? (Number and complexity of problems addressed)
- What decisions were made, and what was the risk of doing or not doing them according to the documentation? (Risk analysis, treatment steps, prescriptions, referrals)
When you approach the MDM table this way, it’s no longer about memorizing definitions. It becomes about reconstructing the patient’s interaction and following the logic of the documented decision-making.
*Mentor Tip* Use highlighters and color-code the three elements in an example chart. It visually reinforces this patterned thinking.
⇒ Step 3: Audit the Data, Not the Documentation Style
We all love a clean, well-written note, but that’s not what we’re auditing.
MDM isn’t scored based on formatting, flow, or even how long the note is. It’s based on AMA Guidelines and Medical Necessity. Period.
This is where bias can quietly sneak in. That seven-page note? It’s easy to skim-it, with a bias of this is a template or copy and paste- get flustered and find little value in the documentation, but that’s not the job of auditing. And the provider who always seems to bill a level 4? You may already be skeptical before you read a single word, but that’s not the job of auditing.
When mentoring, you must first never relay any such biased and ensure you challenge thoughts of such biased thinking.
Auditors should be taught to stay objective. Whether an encounter is a two-paragraph note or a ten-page diatribe, the job is to actively ensure the documentation supports all services rendered, not judge how it was written.
Here’s the truth:
-A templated note doesn’t always equal low complexity.
-A short note can still represent high-level thinking.
– Often, a provider’s reputation precedes them. That “frequent flyer” Level 4 provider might actually be managing a genuinely more complex patient population. More often than not, it means we need to make sure their levels are supported, because there’s a good chance they’re exceeding benchmarks for the right reasons.
*Mentor Tip* Take a sample of three very different note styles, a brief one, a copy-heavy one, and a verbose template, and walk through each side-by-side with your mentee. The goal? Show them how to extract clinical value without letting documentation style cloud their judgment.
⇒ Step 4: Normalize the Gray Areas, and Own Your Judgment
MDM isn’t binary, meaning it’s not simply right or wrong, high or low. It’s layered, influenced by clinical judgment, patient complexity, and documentation that captures the full story of the encounter. Even seasoned auditors can debate risk levels, data points, or how to interpret ambiguous language in documentation.
That’s exactly why mentoring should include walking through edge cases and helping auditors learn how to own their rationale with clarity and confidence.
One of the biggest learning shifts for our E/M Bootcamp attendees at NAMAS is realizing that the answers to our scenario cases don’t always have a single, clear direction. And that’s exactly why we use them—because those gray-area cases are the same ones you face in real-world audit situations. These cases spark powerful learning and meaningful conversations, the kind that naturally build mentorship and strengthen professional growth.
Here’s a key mindset shift: You don’t have to be 100% certain to be 100% professional.
Auditors must be comfortable making a call based on policy, payer guidance, and sound interpretation, and then clearly documenting the “why” behind their decision.
This is also where we introduce the skill of research:
- Use primary sources like CMS, AMA CPT guidance, or specialty-specific recommendations.
- Keep a resource library or reference binder so you’re not starting from scratch each time.
- Avoid relying on third-party blogs or opinions unless they cite a reputable source.
- When in doubt, go upstream. Find the original regulation or manual.
Because part of mentoring is teaching someone how to say: “Based on CPT guidance and CMS instruction, here’s how I arrived at this level.”
*Mentor Tip* Have your mentee write a two- to three-sentence rationale for each MDM level they assign and then cite the guideline or policy they used to get there. Talk it through together. It not only builds accuracy, it builds credibility.
⇒ Step 5: Practice With Purpose, Don’t Just Review, Reflect
The best mentoring doesn’t stop at review. It pushes reflection.
After each case they audit, ask: What made this easy? What tripped you up? What would you ask the provider if you could?
Reflection turns repetition into mastery.
*Mentor Tip* Recommend your mentee keeps a “Wins & What-I-Would-Do-Differently” journal during your mentoring series. They will see growth in real-time.
⇔ Mentoring someone through MDM isn’t about giving them the answers, it’s about helping them build their own framework for problem solving E/M decision-making.
Shannon O. DeConda, CPC, CPMA, CEMA, CEMC, CPA-EDU
As Founder and President of NAMAS, and VP of Regulatory Compliance at DoctorsManagement, I’ve spent over 20 years equipping auditors, coders, and compliance professionals to lead with confidence—through rigorous education, practical mentorship, and a commitment to raising the bar for compliance excellence.
