General Surgery Coding Alert

Question: We recently started using a CDSM module for imaging services in our surgical practice. Do the surgeons have to use this software themselves, or can clinical staff do it?

Codify Subscriber

Answer: The clinician who is ordering the test needs to get on the software, because it involves a decision tree and questions about the patient that the physician must answer.

Context: The clinical decision support module (CDSM) is software that allows clinicians, such as surgeons, to consult appropriate use criteria (AUC) for advanced diagnostic imaging for Medicare patients (like CT, PET, or nuclear medicine). This is part of a mandate by Medicare to ensure that practitioners don't order imaging tests that aren't medically necessary.

Starting July 1, 2018, providers may use modifier QQ (Ordering professional consulted a qualified clinical decision support mechanism for this service and the related data was provided to the furnishing professional) to show that they consulted a CDSM and alerted the radiologist or other furnishing professional that the order demonstrates "appropriate use" based on the module.

Appending modifier QQ is voluntary-for now. "We have a long ramp-up period, but it's going to go by in a heartbeat," says Cindy C. Parman, CPC, CPC-H, RCC, AHIMA Approved ICD-10-CM trainer and executive vice president of Coding Strategies, Inc.

"This is going to be a lot of work. Talk to your doctors because this is going to be physician time," Parman warns. The CDSM software may link into your electronic health records (EHR), but with some systems it will be an entirely separate program.

What if your surgeon doesn't agree with the CDMS' recommendation? You can override it, but think twice, says Parman. CMS will identify individuals that consistently override the CDSM and they will be put on pre-authorization for those tests. This program is intended to save CMS $200 million over the next 10 years.