is the visit appropriate

Common Sense Media

Movie & TV reviews for parents

• For Parents
• For Educators
• Our Work and Impact

Or browse by category:

• Movie Reviews
• Best Movie Lists
• Best Movies on Netflix, Disney+, and More

Common Sense Selections for Movies

50 Modern Movies All Kids Should Watch Before They're 12

• Best TV Lists
• Best TV Shows on Netflix, Disney+, and More
• Common Sense Selections for TV
• Video Reviews of TV Shows

Best Kids' Shows on Disney+

Best Kids' TV Shows on Netflix

• Book Reviews
• Best Book Lists
• Common Sense Selections for Books

8 Tips for Getting Kids Hooked on Books

50 Books All Kids Should Read Before They're 12

• Game Reviews
• Best Game Lists

Common Sense Selections for Games

• Video Reviews of Games

Nintendo Switch Games for Family Fun

• Podcast Reviews
• Best Podcast Lists

Common Sense Selections for Podcasts

Parents' Guide to Podcasts

• App Reviews
• Best App Lists

Social Networking for Teens

Gun-Free Action Game Apps

Reviews for AI Apps and Tools

• YouTube Channel Reviews
• YouTube Kids Channels by Topic

Parents' Ultimate Guide to YouTube Kids

YouTube Kids Channels for Gamers

• Preschoolers (2-4)
• Little Kids (5-7)
• Big Kids (8-9)
• Pre-Teens (10-12)
• Teens (13+)
• Screen Time
• Social Media
• Online Safety
• Identity and Community

How to Help Kids Build Character Strengths with Quality Media

• Family Tech Planners
• Digital Skills
• All Articles
• Latino Culture
• Black Voices
• Asian Stories
• Native Narratives
• LGBTQ+ Pride
• Best of Diverse Representation List

Multicultural Books

YouTube Channels with Diverse Representations

Podcasts with Diverse Characters and Stories

• Common Sense Says
• Parents Say 20 Reviews
• Kids Say 83 Reviews

Common Sense Media Review

Shyamalan's found-footage spooker has teens in peril.

Parents Need to Know

Parents need to know that The Visit is a found-footage horror movie from director M. Night Shyamalan. There are plenty of spooky images, sounds, and dialogue, as well as jump scares and a small amount of blood and gore. Viewers see dead bodies (including one killed in a rather shocking way), and two teens, 13…

Why Age 13+?

Dead bodies, one hanged. Elderly man killed in a shocking way. Some blood. Spook

"F--k" is used once. Other words include "s--t," "ass,&

Minor innuendo involving 13-year-old boy who imagines himself a ladykiller. Nana

Skype is used as part of the plot. Sony laptop shown. A Yahtzee! game, with refe

Adults occasionally smoke cigarettes. A boy mimes "pot smoking" with h

Any Positive Content?

Teens learn to overcome past fears to deal with current situations. They sometim

The main characters are teens (13 and 15) who try their best to survive a bad si

Violence & Scariness

Dead bodies, one hanged. Elderly man killed in a shocking way. Some blood. Spooky images, spooky dialogue, and jump scares. Stabbing with a mirror shard. Teens in jeopardy. Vomiting and poop. A man briefly assaults another man. Rifle briefly shown.

Did you know you can flag iffy content? Adjust limits for Violence & Scariness in your kid's entertainment guide.

"F--k" is used once. Other words include "s--t," "ass," "ho," "bitch," "goddamn," "hell," "douche," and possibly "a--hole." Middle finger gesture.

Did you know you can flag iffy content? Adjust limits for Language in your kid's entertainment guide.

Sex, Romance & Nudity

Minor innuendo involving 13-year-old boy who imagines himself a ladykiller. Nana's naked bottom is shown twice.

Did you know you can flag iffy content? Adjust limits for Sex, Romance & Nudity in your kid's entertainment guide.

Products & Purchases

Skype is used as part of the plot. Sony laptop shown. A Yahtzee! game, with references to toy companies Hasbro and Milton Bradley.

Drinking, Drugs & Smoking

Adults occasionally smoke cigarettes. A boy mimes "pot smoking" with his fingers.

Did you know you can flag iffy content? Adjust limits for Drinking, Drugs & Smoking in your kid's entertainment guide.

Positive Messages

Teens learn to overcome past fears to deal with current situations. They sometimes work together but at other times are forced to split up.

Positive Role Models

The main characters are teens (13 and 15) who try their best to survive a bad situation; they're brave, but their situation isn't one anyone would emulate. The adults in the story aren't particularly admirable.

Parents need to know that The Visit is a found-footage horror movie from director M. Night Shyamalan . There are plenty of spooky images, sounds, and dialogue, as well as jump scares and a small amount of blood and gore. Viewers see dead bodies (including one killed in a rather shocking way), and two teens, 13 and 15, are frequently in peril. The 13-year-old boy fancies himself a ladykiller, which leads to some minor innuendo, and the "Nana" character's naked bottom is shown a couple of times. Language includes a use of "f--k," plus "s--t," "bitch," and more, most frequently spoken by the 13-year-old. Adult characters infrequently smoke cigarettes, and there's a very brief, mimed reference to smoking pot. Shyamalan is a filmmaker whom horror hounds love to hate, but this movie could be a comeback that fans will want to see. To stay in the loop on more movies like this, you can sign up for weekly Family Movie Night emails .

Where to Watch

Videos and photos.

Parent and Kid Reviews

• Parents say (20)
• Kids say (83)

Based on 20 parent reviews

What's the Story?

Thirteen-year-old Tyler ( Ed Oxenbould ) and 15-year-old Becca (Olivia DeJonge) agree to spend a week with their grandparents while encouraging their mom ( Kathryn Hahn ) to take a vacation with her boyfriend. The kids have never met their grandparents, "Nana" (Deanna Dunagan) and "Pop Pop" (Peter McRobbie), at least partly because when their mother left home 15 years earlier, something terrible apparently happened. At first things seem fine, but then Nana and Pop Pop start behaving strangely. Even if it can all be explained -- Nana gets "sundown" syndrome, and Pop Pop requires adult diapers -- it doesn't quite ease the feeling that something's wrong. Meanwhile, Becca documents their visit on video, hoping to capture something that explains it all.

Is It Any Good?

After several perplexing misfires, writer/director M. Night Shyamalan has scaled back, gone for a lower budget and a lighter tone, and emerged with his most effective movie in over a decade. THE VISIT begins interestingly; the potentially creepy moments can be easily explained away and even laughed off, but the director still manages to create a subtle, creeping dread that steadily builds toward the climax.

Shyamalan uses the found-footage concept with more creativity than most other filmmakers, displaying his usual intriguing grasp of three-dimensional space, as well as empty space. The characters themselves are even aware of certain cinematic theories that could make their "documentary" more interesting. They're refreshingly intelligent and self-aware, and they never blunder stupidly into any situation. If the movie has a drawback, it's that fans will be looking hard for clues to one of Shyamalan's big "twists." As to what it is, or whether there is one, we're not saying.

Talk to Your Kids About ...

Families can talk about The Visit 's violence . How much is shown, and how much is suggested? How did it affect you? What's the impact of media violence on kids?

Tyler considers himself a "ladykiller." Is his dialogue inappropriate for someone his age?

Tyler likes to rap and posts videos of himself. Is he expressing himself, or is he merely seeking fame? What's appealing about fame? Is it OK for kids to start their own online channels?

Movie Details

• In theaters : September 11, 2015
• On DVD or streaming : January 5, 2016
• Cast : Kathryn Hahn , Ed Oxenbould , Olivia DeJonge
• Director : M. Night Shyamalan
• Inclusion Information : Indian/South Asian directors, Female actors
• Studio : Universal Pictures
• Genre : Horror
• Run time : 94 minutes
• MPAA rating : PG-13
• MPAA explanation : disturbing thematic material including terror, violence and some nudity, and for brief language
• Last updated : July 24, 2024

Did we miss something on diversity?

Research shows a connection between kids' healthy self-esteem and positive portrayals in media. That's why we've added a new "Diverse Representations" section to our reviews that will be rolling out on an ongoing basis. You can help us help kids by suggesting a diversity update.

Suggest an Update

What to watch next.

The Stepfather

The Blair Witch Project

Best horror movies, scary movies for kids.

Common Sense Media's unbiased ratings are created by expert reviewers and aren't influenced by the product's creators or by any of our funders, affiliates, or partners.

The Visit (I) (2015)

• Parents Guide

Certification

• Sex & Nudity (2)
• Violence & Gore (4)
• Profanity (2)
• Alcohol, Drugs & Smoking (1)
• Frightening & Intense Scenes (6)
• Spoilers (5)

Sex & Nudity

• Mild 112 of 181 found this mild Severity? None 28 Mild 112 Moderate 33 Severe 8 We were unable to submit your evaluation. Please try again later.
• An old woman is seen nude from the back; however, it's dark but still clear rear nudity. Edit
• We also see a seen where an old woman stands up and see a glimpse of some rear nudity from side of her skirt. Edit

Violence & Gore

• Moderate 61 of 91 found this moderate Severity? None 5 Mild 17 Moderate 61 Severe 8 We were unable to submit your evaluation. Please try again later.
• Some images of dead bodies are shown towards the end of the film. Edit
• The children, particularly towards the end of the film, are cruelly terrorised. Edit
• A body is seen hanging from afar. Brief. Edit
• It is implied that the the boy has been hit on the head with an object. Brief mild injury detail. Edit
• Mild 53 of 86 found this mild Severity? None 2 Mild 53 Moderate 26 Severe 5 We were unable to submit your evaluation. Please try again later.
• A middle finger gesture and some uses of "shit" is also present. Edit
• 2 uses of "fuck", and a few uses of "shit", "hell", and "bitch". Edit

Alcohol, Drugs & Smoking

• Mild 47 of 78 found this mild Severity? None 29 Mild 47 Moderate 1 Severe 1 We were unable to submit your evaluation. Please try again later.
• Grandmother smokes a cigarette at one point in the film. Edit

Frightening & Intense Scenes

• Severe 67 of 105 found this severe Severity? None 3 Mild 7 Moderate 28 Severe 67 We were unable to submit your evaluation. Please try again later.
• Grandma crawls around, chasing the kids through the crawl space. She is very fast in this scene, and it contains a couple jump scares. Edit
• Towards the end of the film, a boy who is severely germophobic has a used adult diaper smeared on his face. We don't see the direct act happening but we hear the noise and see the aftermath. Edit
• A psychotic old lady vomits onto a young girl and she cries. Edit
• A girl opens a door to leave the house and sees a corpse hanging from a noose. Edit
• An elderly man is seen putting a rifle in his mouth before pulling it out when he realizes he is being watched. Edit
• An elderly woman asks a young girl to climb inside of an oven to clean it. This happens twice, but nothing comes of it. Edit

The Parents Guide items below may give away important plot points.

• The murder of the real grandparents is implied, and the dead bodies are briefly shown. Edit
• The fake 'Nana' is stabbed with a shard of glass repeatedly, with some brief blood. The act is brief and dark, which lessens the impact. Edit
• The fake 'Pop Pop' is repeatedly tackled shoved, then it is implied that his head is smashed between a fridge and a fridge door. Edit
• Multiple intense scenes where the fake grandparents chase the kids. Some intense jump scares, and a scene where the fake nana runs around the house with a butcher knife. This movie has a very eerie vibe. Edit
• A young girl is going through a basement and briefly sees the corpses of her real grandparents in a dumpster. Edit

Taglines | Plot Summary | Synopsis | Plot Keywords

• Plot Summary
• Plot Keywords
• Full Cast and Crew
• Release Dates
• Official Sites
• Company Credits
• Filming & Production
• Technical Specs

Did You Know?

• Crazy Credits
• Alternate Versions
• Connections
• Soundtracks

Photo & Video

• Photo Gallery
• Trailers and Videos
• User Reviews
• User Ratings
• External Reviews
• Metacritic Reviews

Related Items

• External Sites

Related lists from IMDb users

Recently Viewed

Children’s Check-Ups: Why Well-Visits Matter

By tamira daniely.

August 30, 2024

Top image via iStock from Rawpixel

Parents want their kids to grow up healthy, happy, and thriving. Routine check-ups and preventive health care services are an important part of achieving this. But too many California kids are not getting these key services.   

Children Now’s Preventive Services Chartbook reveals that less than half of the infants and toddlers enrolled in Medi-Cal are receiving essential check-ups at a time in their lives when healthy development is so critical. Well-child visits are not just routine appointments. They are also vital touchpoints for families in understanding developmental milestones, creating healthy habits and behaviors, and connecting with other programs, services, and community resources.  

This alarming statistic should be a wake-up call for all of us.  

The Importance of Well-Child Visits as Family Touchpoints  

For any caregiver who has taken their kid to the pediatrician, they know that well-child visits are much more than just a time for vaccinations and physical exams. During these visits, pediatricians assess a child’s physical and emotional needs, support their growth and development, and refer for additional care if issues arise. These visits also provide an opportunity for parents to discuss concerns and receive guidance on topics such as nutrition, sleep safety, and age-appropriate development and behavior. This is true for dads too, not just moms:  

During well-child visits, pediatric health professionals can engage fathers in conversations about safe sleep, breastfeeding, father-child bonding, and early childhood development.

During a well-child visit, a pediatrician might also identify a need for additional supports and refer the family to other programs or services to meet the child and their caregivers’ needs. These referrals coming from a trusted source like pediatric primary care providers and practices is crucial – parents are more likely to enroll in food assistance programs if pediatricians inform them about their eligibility. This demonstrates the power of these visits as touchpoints for connecting families to a broader network of resources. Given the important connection parents have with their pediatricians, there is a lot of opportunities for healthcare providers to support the overall well-being of families, including through referrals to nutrition and food programs.  

Well-child visits not only ensure baby’s healthy development, but serve as a resource for caregivers and parents to learn and get connected to other necessary services.

Focusing on Equity in Improving Well-Child Visit Rates  

Before the pandemic, many kids, especially those from communities of color, were already missing out on essential check-ups and preventive services. Structural barriers to accessing healthcare, including transportation issues, language differences, lack of childcare, and financial constraints, played a role.   

COVID-19 then made things even worse. Parents of young children shared that the pandemic made it harder to access prenatal care, educational resources, and other support services. Research shows that these challenges only made existing disparities in child healthcare worse,  so the racial disparities in well-child visit attendance and infant health care widened. As a result, Black, American Indian/Alaska Native, and Native Hawaiian/Other Pacific Islander children in California still have the lowest rates of preventive care visits.  

On top of the harm the pandemic had on access to preventative services, it is important to recognize that historical and ongoing experiences of discrimination and bias in the healthcare system have led to a lack of trust among some communities of color. This mistrust can result in reluctance to seek care, even for preventive services. It is important for families to feel heard and supported to gain trust, and to achieve this, cultural competency – the ability to understand, appreciate and interact with people from cultures or belief systems different from one’s own – is key.  

For healthy development, culturally competent providers are critical in ensuring effective and proactive well-child visits. Implicit bias among healthcare providers or a failure to identify cultural distinctions in kid’s behavior can lead to underdiagnosis or misdiagnosis of developmental delays in Black children. Studies have shown that Black children are less likely to be diagnosed with conditions like autism compared to their White peers, and when they are diagnosed, it often occurs later, delaying critical early interventions.  

It’s more important than ever to address this racial disparity issue with a focus on equity. We need to ensure that all children, regardless of their background, have access to the healthcare they need to thrive. By tackling these disparities head-on, we can help build a healthier future for all our kids.  

Transforming Health Care for Kids  

The Medi-Cal program – the cornerstone of coverage for California children – is undergoing a number of transformations to improve children’s preventive services and bridge divides between public health and social services sectors, as well as the communities they serve. Primary care is a central point where transformation can occur through “closed loop referrals” and “warm handoffs” that ensure families get connected to and actually receive the care and services they need beyond primary care.   

As Dr. Palav Babaria, Chief Quality Officer and Deputy Director of Quality and Population Health Management at the California Department of Health Care Services, said in a recent podcast (20:18) regarding the goals of the Medi-Cal transformation initiatives, the state is “really thinking about underutilization—who’s not showing up at our front door? We know so much of that drives a lot of the racial and ethnic disparities we see. How do we think about re-engaging primary care as the front door of our delivery system ?”  

Since there are many kids – roughly half of all children and youth with Medi-Cal – who never show up to the “front door” of the health care system, they end up missing out on timely preventive care services like screenings, immunizations, connection to dental care, and referrals to other supports, specialists, or services they may need. Transformational efforts to eliminate structural barriers so that children have continuous access to culturally-competent primary care providers will be necessary to close the health equity gap and ensure all children have the opportunity to grow up healthy and strong.  

• Type 2 Diabetes
• Heart Disease
• Digestive Health
• Multiple Sclerosis
• Diet & Nutrition
• Health Insurance
• Public Health
• Patient Rights
• Caregivers & Loved Ones
• End of Life Concerns
• Health News
• Thyroid Test Analyzer
• Doctor Discussion Guides
• Hemoglobin A1c Test Analyzer
• Lipid Test Analyzer
• Complete Blood Count (CBC) Analyzer
• What to Buy
• Editorial Process
• Meet Our Medical Expert Board

Dos and Don'ts for Visiting Patients in the Hospital

It might surprise you to know that hospital visitors can be safety hazards who potentially introduce problems to the patients they hope to cheer or assist. The problems may be directly related to physical harm, or may even be mental or emotional.

It can be difficult to visit a patient in the hospital, but you can have a positive influence on your friend or loved one's recovery if you follow some simple visitor guidelines. Knowing the dos and don'ts may give you the confidence you need.

Ask for permission to visit

Wash your hands

Consider allergies and restrictions on decorations and gifts

Turn off cell phone

Keep visit short

Leave if doctor or provider arrive

Visit if you might be contagious

Bring young children

Bring food without checking on restrictions

Cause stress

Avoid visiting

Smoke before or during visit

Dos for Hospital Visitors

Do ask the patient's permission to visit before you arrive . Ask them to be candid with you, and if they prefer you not visit, ask them if another day would be better, or if they would prefer you visit once they get home. Many patients love visitors, but some just don't feel up to it. Do the patient the courtesy of asking permission.

Do wash or sanitize your hands . Do this before you touch the patient or hand the patient something. After touching any item in the room, wash or sanitize your hands again. Infections come from almost any source and the pathogens can survive on surfaces for days. Don't risk being responsible for making your favorite patient even sicker than they already are.

Do wear a mask . Regardless of current hospital rules, wearing a face mask can help protect both the patient and visitor from airborne viruses. If you do not have a mask, the hospital should be able to provide you with one.

Do check before bringing balloons or flowers . If your patient shares a hospital room, you won't want to take either, because you don't know if the roommate has an allergy. Most solid color balloons are latex rubber, and some people are allergic to latex . When in doubt, take mylar balloons or don't take any at all.

Do consider alternative gifts . A card, something a child has made for you to give to the patient, a book to read, a crossword puzzle book, even a new nightgown or pair of slippers are good choices. The idea isn't to spend much money; instead, it's about making the patient feel cared for without creating problems that might trigger an allergic reaction.

Do turn off or silence your cell phone . Different hospitals have different rules about where and when cell phones can be used. In some cases, they may interfere with patient-care devices, so your patient can be at risk if you don't follow the rules. In other cases, it's simply a consideration for those who are trying to sleep and heal and don't want to be annoyed by ringtones.

Do stay for a short time . It's the fact that you have taken the time to visit, and not the length of time you stay, that gives your patient the boost. Staying too long may tire them out. Better to visit more frequently but for no more than a half hour or so each time.

Do leave the room if the doctor or provider arrives to examine or talk to the patient . The conversation or treatment they provide is private, and unless you are a proxy, parent, spouse, or someone else who is an official advocate for the patient, that conversation is not your business. You can return once the provider leaves.

Do follow all hospital policies and staff instructions . Most hospitals have set visiting hours, limits on the number of visitors in the room, and other rules you are expected to follow. Check the hospital's visiting hours and other policies prior to visiting.

Don'ts for Hospital Visitors

Don't enter the hospital if you have any symptoms that could be contagious . Neither the patient nor other hospital workers can afford to catch whatever you have. If you have symptoms like a cough, runny nose, rash or even diarrhea, don't visit. Make a phone call or send a card instead.

During flu season , it is not uncommon for hospitals to restrict visitors to spouses, significant others, family members over 18, and pastors, so it is worthwhile to call the hospital before your visit.

Don't take young children to visit unless it's absolutely necessary . Check with the hospital before you take a child with you. Many hospitals have restrictions on when children may visit.

Don't take food to your patient unless you know they can tolerate it . Many patients are put on special diets while in the hospital. This is especially true for those with certain diseases or even those who have recently had anesthesia for surgery. Your goodies could cause big problems.

Don't visit if your presence will cause stress or anxiety . If there is a problem in the relationship, wait until after the patient is well enough to go home before you potentially stress them by trying to mend that relationship.

Don't expect the patient to entertain you . They are there to heal, not to talk or keep you occupied. It may be better for them to sleep or just rest rather than carry on a conversation. If you ask them before you visit, gauge their tone of voice as well as the words they use. They may try to be polite, but may prefer solitude at this time instead of a visit.

Don't stay home because you assume your friend or loved one prefers you not visit . You won't know until you ask, and your friend or loved one will appreciate the fact that you are trying to help by asking the question.

Don't smoke before visiting or during a visit, even if you excuse yourself to go outdoors . The odor from smoke is nauseating to many people, and some patients have a heightened sense of smell while taking certain drugs or in the sterile hospital environment. At most, it will cause them to feel sicker, and if your friend is a smoker, you may cause them to crave a cigarette.

Johns Hopkins Medicine. Patient safety and quality .

By Trisha Torrey  Trisha Torrey is a patient empowerment and advocacy consultant. She has written several books about patient advocacy and how to best navigate the healthcare system. 

Family Life

AAP Schedule of Well-Child Care Visits

Parents know who they should go to when their child is sick. But pediatrician visits are just as important for healthy children.

The Bright Futures /American Academy of Pediatrics (AAP) developed a set of comprehensive health guidelines for well-child care, known as the " periodicity schedule ." It is a schedule of screenings and assessments recommended at each well-child visit from infancy through adolescence.

Schedule of well-child visits

• The first week visit (3 to 5 days old)
• 1 month old
• 2 months old
• 4 months old
• 6 months old
• 9 months old
• 12 months old
• 15 months old
• 18 months old
• 2 years old (24 months)
• 2 ½ years old (30 months)
• 3 years old
• 4 years old
• 5 years old
• 6 years old
• 7 years old
• 8 years old
• 9 years old
• 10 years old
• 11 years old
• 12 years old
• 13 years old
• 14 years old
• 15 years old
• 16 years old
• 17 years old
• 18 years old
• 19 years old
• 20 years old
• 21 years old

The benefits of well-child visits

Prevention . Your child gets scheduled immunizations to prevent illness. You also can ask your pediatrician about nutrition and safety in the home and at school.

Tracking growth & development . See how much your child has grown in the time since your last visit, and talk with your doctor about your child's development. You can discuss your child's milestones, social behaviors and learning.

Raising any concerns . Make a list of topics you want to talk about with your child's pediatrician such as development, behavior, sleep, eating or getting along with other family members. Bring your top three to five questions or concerns with you to talk with your pediatrician at the start of the visit.

Team approach . Regular visits create strong, trustworthy relationships among pediatrician, parent and child. The AAP recommends well-child visits as a way for pediatricians and parents to serve the needs of children. This team approach helps develop optimal physical, mental and social health of a child.

More information

Back to School, Back to Doctor

Recommended Immunization Schedules

Milestones Matter: 10 to Watch for by Age 5

Your Child's Checkups

• Bright Futures/AAP Recommendations for Preventive Pediatric Health Care (periodicity schedule)

• A-    A+   

The Gift of Presence: Tips for Visiting a Terminally Ill Family Member or Friend

You may think: “I don’t feel like I am doing anything.” … “The person is asleep, or falls asleep, during my visit. Should I wake them? Should I stay?” … “What should I be doing?” … “Am I helping?” or “What should I say to the person?”

Your presence does make a difference. It can be difficult to be with someone who is terminally ill; it isn’t always clear what to do, or say. Intention is everything. The person will sense your tone, pace of the visit and more. If your visit is intended to make the person feel encouraged, cared about, or put a smile on his or her face, the person will sense it.

Below are several helpful suggestions about how to prepare for a visit and ideas to guide you during the visit:

• It’s so important to make sure you are in a place of peace before the visit. If you don’t feel calm, peaceful and centered, take some time to quiet yourself before entering the person’s home or room.
• Always approach the person slowly and quietly so as not to startle them.
• Introduce yourself with a quiet voice. “Hi, it’s your niece, Jane. I would like to sit with you for a while.”
• If you want, hold the person’s hand. Start by telling the person what you are doing. “Mary, I am going to hold your hand now.” Another option is to put the person’s hand on top of yours. That way if the person does not like touch, they can pull away.
• If the person has a book or newspaper by their bed, read it aloud.
• If the person appears to be in and out of sleep, that is okay. They will know they are not alone.

Although it’s natural to be concerned about what you’re going to say, don’t worry so much about the words. The main thing is that your message comes from the heart. It’s also important to remember to stop talking at times and simply listen to the person if he or she is able to communicate.

Here are a couple of tips to help you keep the visit authentic:

• Do say – “It’s good to see you.” Let them know you have been thinking of them.
• At a loss for words – It’s OK to say, “Mary, I don’t know what to say or do, but I’m here and I care about you.”
• Listen – If the person talks about being anxious, listen quietly. Don’t try to change the subject or silence the person. When he or she is finished sharing concerns, encourage him or her by asking, “What do you want to achieve now?” Then you can gently shift the focus of the discussion to that goal rather than the prognosis or condition. For instance, if a person says she wants to live to see her grandbaby be born, ask her how they will celebrate when the baby arrives. Try to keep the conversation positive.
• Chatter is overrated – Be present without saying a word. You don’t have to fill every moment of your visit with conversation. Just make sure you are focused on the person and not thinking about your next appointment or task on the “to-do” list.

About Hospice of the Red River Valley In 1981, Hospice of the Red River Valley was founded on the belief that everyone deserves access to high-quality end-of-life care. We fulfill our nonprofit mission by providing medical, emotional, personal and spiritual care, as well as grief support to our patients, their families and caregivers during a tender time in life. Our staff helps those we serve experience more meaningful moments through exceptional hospice care, 24 hours a day, 365 days a year, wherever a patient calls home. The organization serves more than 40,000 square miles in North Dakota and Minnesota , including in and around Bismarck, Detroit Lakes, Devils Lake, Fargo, Fergus Falls, Grand Forks, Lisbon, Thief River Falls, Valley City and many more communities. Hospice of the Red River Valley offers round-the-clock availability via phone, prompt response times and same-day admissions, including evenings, weekends and holidays. Contact us anytime at 800-237-4629 or hrrv.org .

Return to the blog homepage →

Other Articles that May Interest You

When someone you care about or love has been told they only have a few…

by Sharon Dardis, guest blogger Many caregivers worry about what will happen to their loved…

With the support of Hospice of the Red River Valley, Bob and his daughters were…

Stay Connected

ENTER YOUR EMAIL ADDRESS

You can find additional stories, articles, tips and guides on our blog or in our  resources section. Or, please contact us, anytime, with questions. 

Preventive Health Care Visits in Adolescents

Annual health care visits (also called well-child visits) allow doctors and other health care professionals to monitor physical growth and sexual maturation (puberty) and provide advice and counseling. The yearly health care visits for adolescents begin at age 11 and continue until about age 21.

Routine health care also includes a review of the immunization record and administration of recommended vaccines .

Doctors also may encourage activities such as participation in sports, the arts, and community service. Most doctors interview and examine adolescents privately, although parents may be invited to participate and share concerns and receive their own counseling and guidance at the beginning or end of the visit.

(See also Adolescent Development and Problems in Adolescents .)

Examination

At each visit, screenings may be done and vaccinations are given depending on the schedule.

The adolescent's height, weight, and blood pressure are measured at every yearly health care visit. The doctor then does a complete physical examination.

Once children become adolescents, certain areas of the body require a more detailed examination. For example, examination of the skin for acne, evaluation of the degree of puberty, and examination of the back for scoliosis are particularly important in adolescence.

A pelvic examination is not usually necessary in adolescent girls but may be appropriate if they have certain problems, such as vaginal bleeding or discharge, or if sexual abuse is suspected. The pelvic examination may include an examination of the external genitals (called the vulva or labia) or, if necessary, an internal examination.

The doctor may educate girls about breast self-awareness to become familiar with the usual appearance and feel of their breasts. If girls notice changes in how their breasts appear or feel (for example, masses, thickening, or enlargement), they should see a doctor. Girls are not advised to routinely do a breast self-examination , such as every week or month, because this has not been shown to be an effective method of screening for breast cancer .

Older adolescent boys are examined for testicular masses, and boys of all ages are examined for inguinal hernias . The doctor may educate adolescent boys about testicular self-examination to identify masses.

A blood cholesterol level test should be done for all children between 9 and 11 years of age and again between 17 and 21 years of age. More frequent testing may be recommended for young children and adolescents with obesity or those with a family history of high cholesterol or heart disease.

Adolescents are screened for tuberculosis (TB) risk factors with a questionnaire at all well-child visits. Risk factors include exposure to TB, being born in or having traveled to areas of the world where TB is common (countries other than the United States, Canada, Australia, and New Zealand and Western and North European countries), having a family member who has TB, and having parents or close contacts who are recent immigrants from an area where TB is common or who have recently been in jail. Those with risk factors then usually have tuberculosis screening tests done.

Once adolescents are sexually active, doctors may screen them every year for common sexually transmitted infections (STIs) , such as gonorrhea and chlamydia . Screening is done using samples of urine or samples taken from the rectum, urethra, cervix, or throat.

Doctors may screen an adolescent for human immunodeficiency virus (HIV) infection at least once between the ages of 15 years and 18 years. HIV screening should be done every year for adolescents who are sexually active, have another STI, or use or have used injection drugs. Screening is done with a sample of blood.

Doctors generally begin screening women for cervical cancer at age 21 years. Screening is done with samples of cells taken from the cervix ( Pap test ).

All people should be routinely screened for hepatitis C virus (HCV) infection at least once between the ages of 18 and 79. People at increased risk of HCV infection, including those who have used or who currently use injection drugs, should be tested for HCV infection and reassessed every year. Screening is done with a sample of blood.

Most of a routine health care visit involves a psychosocial screening interview and counseling. The screening interview includes questions regarding the home environment, academic achievement and goals, activities and hobbies, engagement in risk-taking behaviors , mental health , and emotional health . Counseling usually revolves around physical and psychosocial development , healthy lifestyles, and injury prevention.

Injury prevention is discussed with adolescents. Counseling typically includes wide-ranging topics such as

The importance of wearing seatbelts

The dangers of drinking and driving and texting and driving

The dangers of developing a drug or alcohol use disorder

Responsible sexual behavior

Internet and app dangers and appropriate cautions

Violence prevention

Nutrition and exercise

Overweight and obesity are common in the United States and are associated with heart disease and type 2 diabetes. To combat the risk of obesity, parents should continue to provide adolescents with healthy food choices and limit their intake of unhealthy foods. Soda and excessive fruit juice drinking have been implicated as major contributors to obesity.

Inactivity is directly linked to obesity. Screen time (for example, television, video games, cell phones and other handheld devices, and noneducational computer time) may result in inactivity and obesity. Limits on the time a child spends using devices with screens should start at birth and be maintained throughout adolescence. Participation in sports and physical activity should continue to be encouraged as adolescents age.

Copyright © 2024 Merck & Co., Inc., Rahway, NJ, USA and its affiliates. All rights reserved.

• Cookie Preferences

• Skip to main content
• Skip to secondary menu
• Skip to primary sidebar
• Skip to secondary sidebar
• Skip to footer

The Importance of Between-Visits Appointments and Mental Health

by Loren Larsen, CEO, Videra Health 08/27/2024 Leave a Comment

The causes and effects of America’s mental health crisis  are well-documented. Easing access to necessary clinical help has not grown in tandem.

A study by the National Council for Mental Well-Being reveals that  mental health services in the U.S. are insufficient  despite more than half of Americans (56 percent) seeking help, with limited options and long waits becoming the norm. In some ways, meeting patients where they are is optimized, thanks to telehealth tools such as Zoom enabling 24-7 remote appointments, and wellness surveys becoming accessible anywhere, anytime by patients and providers. Yet, paradoxically, more people are not getting the help they need when they need it.

One critical challenge the U.S. mental healthcare system faces is how to leverage the available tools to accommodate a stressed population, and an even more stressed healthcare system.

Nationwide shortage

During the height of the COVID-19 pandemic, 40 percent of adults reported symptoms of anxiety or depression, according to data from the  Kaiser Family Foundation . That figure  fell to 28 percent as of Feb. 2023  — still a sizable jump compared to 11 percent before the pandemic.

Meanwhile, a nationwide shortage of mental health professionals has exacerbated a nationwide emergency. A 2016 report by the  Department of Health and Human Services  projected shortages for psychiatrists; clinical, counseling, and school psychologists; mental health and substance use social workers; school counselors; and marriage and family therapists. From 1995 to 2014, the US population increased by 37 percent and the number of physicians increased by 45 percent.  The number of psychiatrists grew by only 12 percent  during that same timeframe.

The effect is predictable:  According to the most recent annual survey by the American Psychological Association , more than half of psychologists reported they have no openings for new patients. Among those who keep waitlists, the average wait time was three months or longer.

The mental health crisis for the general population has been a logistical nightmare for providers. Since there aren’t enough professionals to meet the demand for mental health services, how do clinicians prioritize who gets seen? The nature of mental health issues makes the question perhaps more difficult to answer than for any clinical discipline.

Importance of continual monitoring

A patient who sees a doctor for a broken arm at least has the luxury of history. Over hundreds of years of practicing medicine, we know how long it takes a bone to heal, allowing doctors to schedule follow-up visits accordingly. For patients dealing with physical conditions from pregnancy to surgery recovery, knowing when to schedule the second visit is the easy part.

The same is not true for mental health. A patient who feels fine, sounds fine, and looks fine at the time of their appointment might be in crisis the next day. And because of the clinician shortage, the time between each appointment is often longer than desired..

The consequences of this phenomenon are many. If patients with severe symptoms are able to get to an emergency room in time to seek help between appointments, they can at least be seen by a provider on short notice. However, accessing a psychologist or psychiatrist in the ER is a roll of the dice. There’s no telling whether one of these professionals is on duty, or how busy they are. Not only is ER care not optimized for the patient with acute mental health concerns, the lack of mental health services adds to an ER network  already overcrowded with patients seeking care for physical emergencies .

As mental health care providers switched their preferred medium from in-person to remote visits, the range of patient solutions expanded. Can further advancements in video and other technologies help meet patients’ needs between appointments?

AI and Remote Care Solutions

The COVID-19 pandemic catalyzed the transition from in-person to remote mental health care, from 39.4 percent of appointments in 2019 to 88.1 percent in 2022. Besides making appointments with professionals more accessible to more people, the transition to remote-first care normalized video calling services (Zoom,  et.al .) in the minds of both providers and patients.  According to the National Alliance on Mental Illness , this eliminated the need to find transportation and decreased “no-shows,” resulting in greater continuity of treatment.

Using the same tools, patients can provide short video recordings between appointments — logging acute mental health episodes such as anxiety attacks, or merely recording their thoughts and feelings in real time. These short videos can be sent to the provider and reviewed asynchronously between scheduled appointments. This offers clinicians the opportunity to “see” their clients on a more regular basis. This method also complements written surveys that ask patients to rate their mental health by a variety of measures on a scale, allowing providers to track their patients’ progress over time.

Because a between-appointments video can be recorded whenever a patient feels their need is most acute, it solves the problem of meeting the patient in a time of need — to a point. How can providers sift through their patients’ videos to determine whose care needs are most acute?

Enter AI. Yesterday’s digital tools were trained to scan patient surveys to flag when someone feels like a 1 on a scale of 1-10, or notify a provider whenever their mood drops sharply. Similarly, today’s machine learning scripts can be trained to “read” a video transcript, analyze the audio of a video for specific vocal cues, and find other signals in the noise that could be cause for concern. All of these tasks can be done quickly, between appointments, without direct intervention from a clinician or other human.

In this way, AI is not acting as a substitute for human care, but rather doing much of the necessary work around assessing and prioritizing patients’ needs that historically preceded in-person visits. In this hybrid clinician/AI care model, the short-term potential to alleviate human workloads in mental health settings is obvious — while also responding to patients’ needs between appointments, when they might be most vulnerable.

The global shortage of mental health professionals and the increased demand for services is a pain point for providers and patients alike. Applying many of the telehealth tools that have gained acceptance in recent years, and leveraging AI to boost their power, carries the potential to reduce the strain on the mental healthcare system and meet more patients where they are.

About Loren Larsen

Loren Larsen is the CEO and co-founder of Videra Health , the leading AI-driven mental health assessment platform that empowers providers and healthcare organizations to proactively identify, triage and monitor at-risk patients to close care gaps using linguistic, audio and video analysis. He is skilled in developing technologies that can analyze human emotion and language with astonishing accuracy has positioned him as a vanguard in applying AI to empathetic healthcare solutions. Prior to Videra, Larsen was the CTO of HireVue, a trailblazing video job interviewing platform with advanced machine learning algorithms. He also co-founded Nomi Health, a direct healthcare company striving to innovate within the healthcare service and technology space.

Reader Interactions

• Advertise with Us
• Reprints and Permissions
• Submit An Op-Ed

Editorial Coverage

• Care Coordination
• Interoperability
• Population Health Management
• Revenue Cycle Management
• Artificial Intelligence
• Blockchain Tech
• Precision Medicine
• Accountable Care
• Medicare Advantage

Subscribe to HIT Consultant Media

Latest insightful articles delivered straight to your inbox weekly

Is It Correct to Say, “Thanks for the Visit?”

By: Author Dr. Patrick Capriola

Posted on Published: June 20, 2022

Grandma comes to see your new house. She has to leave after a little while, so you say, “Thanks for the visit, Grandma!” Was that even appropriate to say?

“Thanks for the visit” is correct to use in casual conversation as a short way of saying “I offer you my thanks for coming to visit” or “I thank you for taking the time to visit.” You can also use it as a nice way of telling someone that it’s time for them to leave if you use it in the right context.

Still, while it is good to use this as a phrase of gratitude, you should avoid using it in highly formal settings. Read on to see how to use “Thanks for the visit” and similar expressions of gratitude in casual and formal situations.

What Does “Thanks for the Visit” Mean?

When we say “Thanks for the visit,” we express our gratitude for someone coming to see us. In casual conversation, it is a quick way to say, “Thank you for coming to visit.” Alternatively, we can use this as a polite way to hint that the visit needs to come to an end.

For example, let’s say you have a housewarming party with family and friends. As people leave, “Thanks for the visit” is appropriate because you appreciate the time they spent with you.

On the other hand, say you have a friend or family member who just loves to hang out, but you really have other things to do, or it’s late. “Well, thanks for the visit” is a polite way to indicate that it’s time for the visit to end. Of course, you are still being nice, but hopefully, they get the subtle hint.

As a noun, a visit is a short stay or a brief residence as a guest. As a verb, to “visit” someone is typically an act of friendship or courtesy where you go to see them for a short period ( source ). We would refer to the person visiting as a guest or visitor.

“Visit” comes from the Latin “ visitare ,” which literally means to go to see ( source ). “Visit” usually has positive connotations, implying the visitor comes to see the person to offer comfort or some benefit. 

However, in certain contexts, “visit” in the sense of “come upon” can have the negative meaning of “afflict” or “impose,” as in a disease or some other disaster. However, this is mainly when using “visit” as a verb and not as a noun.

Is It Grammatically Correct to Say “Thanks for the Visit”?

While “Thanks for the visit” is grammatically incomplete as a sentence fragment with no subject or verb, it still functions grammatically since the listener can infer the subject and verb. Technically, “Thanks for the visit” is a minor or irregular sentence.

A minor sentence is grammatically incomplete, but we still understand its meaning. We can use minor sentences for dramatic effect in conversation to emphasize points and show emotions, usually surprise ( source ).

A similar, complete sentence would be, “I offer my thanks to you for the visit.” “Thanks” is actually a plural noun, so we must add a subject (I) and verb (offer) to complete the sentence ( source ).

“Thanks” is the direct object of the verb “offer” since it is the thing someone is offering. “For” is a preposition and function word indicating the purpose for the thanks. Finally, the noun “visit” serves as the object of the preposition and is the thing the subject is thankful for.

How Do You Use “Thanks for the Visit”?

We use “Thanks for the visit” as a minor sentence when directly interacting with someone in speech or writing. Alternatively, we can use it as part of a full sentence by adding a subject and verb or attaching it to an independent clause using a conjunction.

We can also tag on the name of the individual we’re thanking for the visit after a comma.

When Can You Use “Thanks for the Visit”?

You can say “Thanks for the visit” when someone arrives to see you, as they’re going to leave after visiting you, or when you’re giving them a polite hint that it’s time for them to leave. You can also write this on a card, email, or in a letter after a visit.

The best instances are:

When someone comes for a scheduled visit.

• Thanks for the visit . I appreciate you coming.

You knew the person was coming, so thanking them when they came in is appropriate and thoughtful.

When someone is leaving.

• Thanks for the visit ! It was fun.

As they leave, it is polite to say “Thanks.” Adding “it was fun” sends your visitors home appreciated.

When trying to politely tell someone to leave without being rude.

• Thanks for the visit , but I have an appointment.

You can use the last scenario in situations involving unwanted visitors, such as salespeople. If you are polite but quick, they usually get the point.

In What Context Can You Use “Thanks for the Visit”?

We use “Thanks for the visit” and similar phrases with close family and friends in comfortable conversations and writing. It is also a good way to express that it’s time for someone to leave politely.

For instance, after a housewarming party, saying “Thanks for the visit” to everyone is short and sweet but grateful. Also, when you write a thank-you card, it is an acceptable phrase as long as you are close to the person or group. 

Additionally, saying “Thanks for the visit” to someone who came to see you in the hospital is appropriate. In contrast, saying it to a coworker who came to assist you is probably not the best choice.

Saying “Thanks for the visit” to your grandma might be tricky as it might come across as too short and rude to say to an elder. However, if you and grandma have a close relationship, this could be appropriate.

Let’s take a look at when Grandma comes to see the new house:

• Thanks for the visit , Grandma !

If you want to be more polite and formal to her, using “Thank you for the visit, Grandma!” or “Thank you for visiting me, Grandma!” is more suitable.

With close friends, you are comfortable enough that this phrase won’t be a big deal. But, what about friends of friends that you just met? In that case, it may be better to use “Thank you for the visit” until you develop a closer relationship.

Now, your best friend has been at your house for a while. You are getting tired, so “Thanks for the visit” is a good way to say, “It’s time to go.” However, you can add more to it to make it more obvious.

• Thanks for the visit , but I have to get up for work in the morning.

With this addition, using the conjunction “but,” I emphasize that I need to go to work the next day, so it helps get more to the point.

Using “Thanks for the Visit” in a Full Sentence

To use “Thanks for the visit” in a full sentence, we can add a subject and a verb , such as “I offer my thanks for the visit.” You can also add more context using a conjunction, as in “We had a great time, so thanks for the visit.”

• I offer my thanks for the visit .

“I” becomes the subject, and “offer” is the verb. “Thanks” becomes the direct object / noun, and “for the visit” is still a prepositional phrase. “I offer thanks” seems a little confusing, so adding the possessive pronoun “my” as an adjective before “thanks” is more appropriate.

• We had a great time , so thanks for the visit .

In this case, “We” is the subject, and the verb is “had.” The conjunction “so” indicates that what came before is a reason for their gratitude: “We had a great time.”

When Not to Use “Thanks for the Visit”

Since “Thanks for the visit” is a more casual, abbreviated statement, it’s best to avoid using it in very formal settings or in academic writing. It might come across as rude, abrupt, or sarcastic.

Coworker: I brought over the paperwork that you need to sign.

You: Thanks for the visit!

The coworker might see this as rude and unprofessional. In this situation, it would be better to say “Thank you” and let them know that you’ll sign the paperwork once you have an opportunity. They’re asking you to perform a work-related task for them, so this is not intended as a pleasant visit but an official one.

Even if you believe they’ve visited some horrible thing upon you by asking you to sign the paperwork, that would actually be a visitation and not a visit ( source ).

Similarly, you would not want to say this to a medical professional responsible for your well-being — it could come across as disrespectful and ungrateful. For example, consider the following interaction with a doctor.

Doctor : The results look good! You are going home tomorrow.

You: Thanks for the visit! 

If you were close friends with the doctor, perhaps you could say “Thanks for the visit, Doc!” or even “Thanks, Doc!” in good humor. Otherwise, we would strongly advise against this.

What Can You Use Instead of “Thanks for the Visit”?

While “Thanks for the visit” is decent, there are quite a few other phrases and minor sentences you can use to express gratitude. For instance, you could say “Thanks for seeing me” or “Thanks for stopping by” ( source ).

• Thanks for visiting.
• Thanks for stopping by.
• Thanks for dropping by.
• Thanks for dropping in.
• Thanks for coming to see me.
• Thanks for coming over.

More Formal:

• Thank you for coming.
• Thank you for visiting.

Expressions of Gratitude as Minor Sentences

Since the speaker and listener typically understand the subject, verb, and direct object, many expressions of gratitude take the form of minor sentences. Again, a minor or irregular sentence is one that lacks either a subject or verb or both.

Minor sentences can take the form of aphorisms, exclamations, interjections, or imperatives. “Thanks for the visit” is an abbreviated statement meaning “ I offer my thanks for your visit.”

Interestingly, while “Thanks for the visit” lacks a verb, “Thank you for the visit” does not since “thank” is the verb. Numerous expressions of gratitude as minor sentences use either “Thanks” or “Thank you.”

Make sure to check out “ Is It Correct to Say ‘Thanks for Your Patronage’? ” “ Is It Correct to Say ‘Thanks a Million’? ” and “ Is It Correct to Say, ‘Thank You Very Much’? ” for further examples.

Phrases and Clauses

Phrases and clauses are important sentence elements. The main difference between them is a phrase lacks a subject and verb, while a clause has both. A phrase can be a component of a clause.

A minor sentence is a type of phrase since it is a collection of words that work as a conceptual unit, although phrases are typically short. Also, the meaning of a minor sentence is typically clearer than a phase since a minor sentence carries the intonation of a complete sentence.

For example, “the visit” would be a noun phrase, which is a phrase containing a noun, “visit,” and a noun modifier, the definite article “the.” This noun phrase is also part of a longer prepositional phrase, “for the visit,” beginning with the preposition “for.”

Clauses have a subject and a verb. Independent clauses can form parts of larger sentences, or they can stand alone. Meanwhile, dependent clauses rely on the main clause for their meaning ( source ).

This article was written for strategiesforparents.com.

A compound sentence connects two independent clauses, while complex and conditional sentences require a dependent clause and at least one independent clause.

• Compound sentence: He brought over some milk, so we thanked him for the visit.
• Complex sentence: Since he brought over some milk, we thanked him for the visit.
• Conditional sentence: If he comes over , you should thank him for the visit.

Final Thoughts

When someone takes the time to visit you, “Thanks for the visit” is a friendly and short way of emphasizing gratitude. When your lovely aunt is overstaying her welcome, it is a polite way to say, “Well, it’s about time to end this visit.” Either way, you have another fun phrase for your English vocabulary.

Follow these four steps to code quickly and accurately, while reducing the need to count up data points.

KEITH W. MILLETTE, MD, FAAFP, RPh

Fam Pract Manag. 2021;28(4):21-26

Author disclosure: no relevant financial affiliations.

The new rules for coding evaluation and management (E/M) office visits are a big improvement but still a lot to digest. 1 , 2 To ease the transition, previous FPM articles have laid out the new American Medical Association/CPT medical decision making guide 3 and introduced doctor–friendly coding templates (see “ Countdown to the E/M Coding Changes ,” FPM , September/October 2020), explained how to quickly identify level 4 office visits (see “ Coding Level 4 Visits Using the New E/M Guidelines ,” FPM , January/February 2021), and applied the new guidelines to common visit types (see “ The 2021 Office Visit Coding Changes: Putting the Pieces Together ,” FPM , November/December 2020).

After several months of using the new coding rules, it has become clear that the most difficult chore of coding office visits now is assessing data to determine the level of medical decision making (MDM). Analyzing each note for data points can be time-consuming and sometimes confusing.

That being the case, it's important to understand when you can avoid using data for coding, and when you can't. I've developed a four-step process for this (see “ A step-by-step timesaver ”).

The goal of this article is to clarify the new coding rules and terminology and to explain this step-by-step approach to help clinicians code office visits more quickly, confidently, and correctly.

The new evaluation and management office visit coding rules have simplified many things but are still a lot to digest, especially when it comes to counting data.

There are different levels of data and different categories within each level, which can make using data to calculate the visit level time-consuming and confusing.

By calculating total time, and then moving on to assessing problems and prescription drug management, most visits can be optimally coded without dealing with data at all.

OFFICE VISIT CODING RULES AND TERMINOLOGY

To make full use of the step-by-step process, we have to first understand the new rules, as well as coding terminology. Here is a brief summary.

Medically appropriate . Physicians and other qualified health care professionals may now solely use either total time or MDM to determine the level of service of an office visit. That means the “history” and “physical exam” components are no longer needed for code selection, which simplifies things. But your patient note must still contain a “medically appropriate” history and physical. So continue to document what is needed for good medical care.

New patient . A new patient is a patient who has not been seen by you or one of your partners in the same medical specialty and the same group practice within the past three years.

Total time and prolonged services . Total time includes all the time you spend on a visit on the day of the encounter (before midnight). It includes your time before the visit reviewing the chart, your face-to-face time with the patient, and the time you spend after the visit finishing documentation, ordering or reviewing studies, refilling medications, making phone calls related to the visit, etc. It does not include your time spent performing separately billed services such as wellness visits or procedures. Total time visit level thresholds differ for new patients vs. established patients. (See the total times in “ The Rosetta Stone four-step template for coding office visits .”)

The prolonged services code comes into play when total time exceeds the limits set for level 5 visits by at least 15 minutes.

Medical decision making . MDM is made up of three components: problems, data, and risk. Each component has different levels, which correspond to levels of service (low/limited = level 3, moderate = level 4, and high/extensive = level 5). The highest level reached by at least two out of the three components determines the correct code for the level of service. MDM criteria is the same for new and established patients.

Problems addressed . This includes only the problems you address at that specific patient visit. It does not include all the patient's diagnoses and does not include problems that are exclusively managed by another clinician. Problems addressed are separated into low-complexity problems (level 3), moderate-complexity problems (level 4), and high-complexity problems (level 5). To code correctly, you need to know the coding value of the problems you address. It is helpful to think of problems in terms of levels of service (e.g., a sinus infection is usually a level 3 problem, and pneumonia or uncontrolled diabetes are usually level 4 problems).

The simplest way to summarize problems is this: Life-threatening problems are level 5; acute or chronic illnesses or injuries are level 3 or 4 depending on how many there are, how stable they are, and how complex they are; and if there's just one minor problem, it's level 2.

(For more specifics see “ What level of problem did I address? ”)

Risk . Risk is also separated into “low” (level 3), “moderate” (level 4), and “high” (level 5) categories.

Level 3 risk includes the use of over-the-counter (OTC) medications.

Level 4 risk includes the following:

Prescription drug management: starting, stopping, modifying, refilling, or deciding to continue a prescription medication (and documenting your thought process),

Social determinants of health that limit diagnosis or treatment (this is when patients' lack of finances, insurance, food, housing, etc., affects your ability to diagnose, manage, and care for them as you normally would).

Level 5 risk includes the following:

Decisions about hospitalization,

Decisions about emergency major surgery,

Drug therapy that requires intensive toxicity monitoring,

Decisions to not resuscitate or to de-escalate care because of poor prognosis.

Data analyzed . For purposes of MDM, data is characterized as “limited” (level 3 data), “moderate” (level 4 data), or “extensive” (level 5 data). But each level of data is further split into Categories 1, 2, and 3. This can make calculating data complicated, confusing, and time-consuming. Here are the data components and terms you need to know.

Category 1 data includes the following:

The ordering or reviewing of each unique test , i.e., a single lab test, panel, X-ray, electrocardiogram (ECG), or other study.

Ordering and reviewing the same lab test or study is worth one point, not two; a lab panel (e.g., complete blood count or comprehensive metabolic panel) is worth one point,

Reviewing a pertinent test or study done in the past at your own facility or another facility,

Reviewing prior external notes from each unique source, including records from a clinician in a different specialty or from a different group practice or facility as well as each separate health organization (e.g., reviewing three notes from the Mayo Clinic is worth one point, not three, but reviewing one note from Mayo and one from Johns Hopkins is worth a total of two points),

Using an independent historian, which means obtaining a history from someone other than the patient, such as a parent, spouse, or group home staff member. (This is included in Category 2 for level 3 data, but falls into Category 1 for level 4 and 5 data.)

Category 2 data includes the following:

Using an independent historian (for level 3 data only),

Independent interpretation of tests, which is your evaluation or reading of an X-ray, ECG, or other study (e.g., “I personally reviewed the X-ray and it shows …”) and can include your personal evaluation of a pertinent study done in the past at your or another facility. It does not include reviewing another clinician's written report only, and it does not include studies for which you are also billing separately for your reading.

Category 3 data includes the following:

Discussion of patient management or test interpretation with an external physician, other qualified health care professional, or appropriate source. An external physician or other qualified health care professional is someone who is not in your same group practice or specialty. Other appropriate sources could include, for example, consulting a patient's teacher about the patient's attention deficit hyperactivity disorder.

A STEP-BY-STEP TIMESAVER

The majority of office visits can be optimally coded by using time or by looking at what level of problems were addressed (see Steps 1 and 2 below) and whether a prescription medication was involved.

A level 3 problem can be coded as a level 3 visit if you address it with an OTC or prescription medication. A level 4 problem can be coded as a level 4 visit if you order prescription medication or perform any other type of prescription drug management (modifying, stopping, or deciding to continue a medication). Most level 2 and level 5 office visits are straightforward, and most level 5 visits will be coded by time. They will typically be visits in which you address multiple problems or complicated problems and the total time exceeds 40 minutes for established patients. This is much more common than seeing critically ill patients who may require admission, which is another level 5 scenario. The few remaining patient visits that have not already been coded require analyzing data (Steps 3 and 4). (See “ The Rosetta Stone four-step template for coding office visits .”)

Step 1: Total time . Think time first. If your total time spent on a visit appropriately credits you for level 3, 4, or 5 work, then document that time, code the visit, and be done with it. But if it does not, go to Step 2.

Step 2: “Problems plus.” Don't be afraid to move on from time-based coding if you believe you performed a higher level visit using MDM. Many visits can be coded with MDM just by answering these two questions: What was the highest-level problem you addressed during the office visit? And did you order, stop, modify, or decide to continue a prescription medication?

If you addressed a level 2 problem and your total time was less than 20 minutes (or less than 30 for a new patient), then code level 2.

If you addressed a level 3 problem, plus you recommended an OTC medication or performed prescription drug management, then code level 3.

If you addressed a level 4 problem, plus you performed prescription drug management, then code level 4.

Chronic disease management often qualifies as level 4 work. For documentation, think “P-S-R”: problem addressed, status of the problem (stable vs. unstable), and prescription drug management (Rx). This trio should make it clear to coders, insurance companies, and auditors that level 4 work was performed.

For instance, if a patient has controlled hypertension and diabetes and you document that you decided to continue the current doses of losartan and metformin, that's level 4 (two stable chronic illnesses plus prescription drug management). If you see a patient with even one unstable chronic illness and document prescription drug management to address it, that's also level 4.

For a level 5 problem, if you see a really sick patient and decide to admit or consider admission (and you document your thought process in your note), then code level 5.

By starting with total time and, if necessary, moving on to “problems plus,” you will probably be able to optimally code 90% of your office E/M visits. But on the rare occasions when you see a patient for level 4 or 5 problems for less than the required time and don't do any prescription drug management, you may have to proceed to Steps 3 and 4.

Step 3: Level 4 problem with simple data or social determinants of health concerns . Code level 4 if you saw a patient for a level 4 problem and did any of the following:

Personally interpret a study (e.g., X-ray),

Discuss management or a test with an external physician,

Modify your workup or treatment because of social determinants of health.

Step 4: Level 4 or 5 problem with complex data . If you saw a patient for a level 4 problem and still haven't been able to code the visit at this point, you have to tally Category 1 data points:

Review/order of each unique test equals one point each,

Review of external notes from each unique source equals one point each,

Use of an independent historian equals one point.

Once you reach three points, code it as level 4.

For a level 5 problem, if you see a really sick patient, order/interpret an X-ray or ECG, and review/order two lab tests, then code level 5.

Following these steps should allow you to quickly identify the optimal level to code most any E/M office visit (for pre-op visits, see “ Coding pre-ops template .”)

Here's a catchy rhyme to remember the basic outline of the steps:

To finish fast ,

code by time and problems first ,

and save data for last .

By mastering the new coding rules and terminology and applying this four-step approach, you can code office visits more quickly, accurately, and confidently — and then spend more time with your patients and less time at the computer.

CPT Evaluation and Management (E/M) Office or Other Outpatient and Prolonged Services Code and Guideline Changes . American Medical Association. Accessed June 10, 2021. https://www.ama-assn.org/system/files/2019-06/cpt-office-prolonged-svs-code-changes.pdf

E/M Office Visit Compendium 2021. American Medical Association; 2020.

Table 2 – CPT E/M office revisions level of medical decision making. American Medical Association. Accessed June 10, 2021. https://www.ama-assn.org/system/files/2019-06/cpt-revised-mdm-grid.pdf

Continue Reading

More in FPM

More in pubmed.

Copyright © 2021 by the American Academy of Family Physicians.

This content is owned by the AAFP. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP.  See permissions  for copyright questions and/or permission requests.

Copyright © 2024 American Academy of Family Physicians. All Rights Reserved.

• Mideast News
• Art&Culture
• ynetespanol
• Privacy Policy
• Terms of Use

U.S. Chairman of Joint Chiefs in surprise Middle East trip as Iran threat looms

Brown says his visit is to deter any type of broader escalation and ensure the u. s. is taking all the appropriate steps to avoid a broader conflict .

Iranian response