1. J

    Wiki MDM Grid

    Hi all! I'm relatively new to behavioral health coding and am looking for E&M resources for both outpatient office visits and inpatient psych (for profee). I've been told by co-workers, who work in other specialties, that they've found adapted MDM grids more geared to their specialty. Does...
  2. E

    Wiki Why was I marked wrong? (Practicode Case ID: OPD7085)

    The documentation: Why is the MDM low? There was prescription drug management, combined with discussion with another provider.
  3. N

    Wiki Is face to face required for Subsequent Inpatient?

    I have a provider who noted that when he went to the patient room the patient had been taken to radiology for CT scan. He noted he discussed patient with nursing and then based on labs/previous imaging he adjusted patient medication. There is no physical exam but there is medically relevant hx...
  4. E

    Wiki Why was I marked wrong? (Practicode Case ID: OPD7411)

    The documentation: Doesn't the X-Ray (interpreted by the radiologist) count as independent interpretation of tests? Also, the guidelines say that fulfilling just one of the three categories in that MDM element is enough for that element to be moderate. Then combined with the prescription drug...
  5. S

    Wiki 99214

    Can anyone give me examples of 99214 justifications during a skin exam.
  6. S

    Wiki Low vs. Moderate Risk of Morbidity

    Does anyone have any examples of what would distinguish a low vs. a moderate risk of morbidity? It seems so subjective.
  7. P

    Wiki Medical Decision Making Risk: Morning after pill (Emergency Contraceptive)

    Hello, We are a family planning specialty. Hope I could get a clarification on the MDM risk when provider prescribes a morning after pill (1 tablet). Is this considered as prescription management? Is truly managed when it is considered an emergency contraceptive and not for recurrent use? And...
  8. T

    Wiki External physician/other qualified health care professional/appropriate source

    For 2023 inpatient coding on MDM, the data section in category 3 is discussion with external physician/other qualified health care professional/appropriate source- does a nurse (RN) working on the patients floor count as a 'other qualified health care professional/appropriate source' (my...
  9. J

    Wiki Prescription Drug Management

    Hello all, I have a question in regards to prescription drug management for MDM purposes that myself and other coders in our department have been questioning back and forth for a few months. We work exclusively in the domiciliary and home setting (95/97 guidelines). The patients our providers...
  10. R

    Wiki Shared decision making 2021

    Can you please explain what this means: "management options selected and those considered, but not necessarily selected, after shared medical decision making with the patient and/or family" What happens in the situation where the doctor addresses the patient's conditions and presents that the...
  11. J

    Wiki Do in office procedures count toward MDM column 3?

    If a physician decides to give and bill for an injection during an office visit does this count toward the MDM (column 3)? Patient presented with plantar fasciitis which is progressing in pain over the past several months. The provider then performed below injection: "At this time, the foot...
  12. V

    Wiki Medical Decision Making Table (Number of DXs or Treatment options, DATA Reviewed, and Risk table) Examples for Inpatient Hospital Coding 99221-99239?

    Hi, I wanted to ask if someone can provide me with some links or websites or anything really, that may have a list of common illnesses/injuries that are good examples to use for the different levels of the MDM table for Inpatient Hospital Coding (99221-99239) For example, just like on the Risk...
  13. KStaten

    Wiki Recommendation for Dental prophylaxis Following Joint Replacement- MDM

    Hello, Everyone. :) Dental prophylaxis is often recommended for patients following joint replacement, whereas any vulnerable areas for infection in the body can pose a potential risk. If, however, the doctor documents-- in a routine, yearly exam-- that there are no problems with the...
  14. KStaten

    Wiki E/M Level for Pain Following Hip Replacement (Outside Global Period)

    Hello, everyone. :) Does anyone think this would justify a 99213 with the new guidelines or would it only meet the requirements for a 99212? (Input is greatly appreciated!) -------------------------------------------------------------------------------------------------------------------------...
  15. J

    Wiki E/M Risk billing

    We saw a patient for f/u on a fracture. The cast was removed, but he fitted her with a material splint along with the counseling that goes with it. Also, did an order for x-ray. Would this be a 99213 or 99212? I am confused what the risk element would be for splint fitting and fracture f/u...
  16. KStaten

    Wiki Are Medicare's Guidelines for E/M CPT Codes the same as AMA's?

    Hello, Everyone. :) I would greatly appreciate it if you could please share documentation that shows how "closely" Medicare bases its guidelines in comparison to AMA's rules/ guidelines regarding levels for E/M-- specifically, the MDM table. 😐 It has recently been suggested to me that the rules...
  17. KStaten

    Wiki MDM for Total Hip / Knee Replacement

    Hello Everyone. :) I have gone down a rabbit hole on coding joint replacement surgeries and would 💙GREATLY APPRECIATE💙 your input for confirmation, given the 2021 E/M guidelines. I apologize in advance for the redundancy of this question. A ) In the plan, it is documented that a 65-year-old...
  18. S

    Wiki Medicare Split Visit Question

    There is some confusion of when it is appropriate to split a visit for Medicare IPPE/Initial or Subsequent AWVs utilizing the new E/M MDM if not based upon time for each (IPPE/AWV vs OV) Can a visit be split if all other Medicare requirements are met and the patient has 2+stable chronic...
  19. KStaten

    Wiki E/M for Biceps Rupture

    Greetings Fellow Coders :) Since the E/M level is now based upon MDM only, I have been noticing that providers are still in the habit of billing with the old guidelines in mind, which in some cases, would result in higher levels of E/M. I would really appreciate if others can help me out by...
  20. S

    Wiki MDM data points and obtaining history from someone other than patient

    We were recently told that it is appropriate to give two MDM data points when a patient has a family member in the treatment room, to provide language interpretation. We would appreciate other thoughts and opinions on this. Tara Irvine HIM Director Sky Lakes Medical Center
  21. KatieBrownCPC

    Wiki HELP Well woman Prev Visit vs Office Visit coding

    Need to understand when to code for Prev Visit and When to stick to new patient, all the ICD vs CPT feel backwards from primary diagnosis to visit billed ...TIA New Pt 36 Here for well woman with pap, STI and HIV ICD consists of Z11.3 STI screen Z11.4 HIV screen Z01.419 GYN routine exam...
  22. C

    Wiki Rx management in the ED/ EM Risk Table

    OK...there seems to be some disagreement within my office on Rx Drug Management. The case is: An emergency room provider orders 1 Norco for a patient while he is being assessed in the ED but does not prescribe any long term pain meds on discharge. Some are saying simply ordering the 1 dose is...
  23. J

    Wiki ED Profee rx management

    When assigning Profee E&M levels for emergency room visits are medications administered during the visit considered prescription drug management?
  24. K

    Wiki Obgyn mdm risks

    I'm curious to know opinions on risk for mdm for amenorrhea visits. patient has no health complications, mild nausea and work up is blood work,pap, and ultrasound at the next visit... could one argue that it is an [undiagnosed new problem with uncertain prognosis] since the ultrasound hasn't...
  25. A

    Wiki Data Reviewed Points Scoring for tests ordered, read, AND charged for?

    There are 2 data reviewed points available if the provider orders/reads, interprets a test. I have heard mixed reviews on whether it is acceptable to count the ordering/reading of a test that is also billed to the insurance co. For instance, the provider performs an EKG and interprets it. That...
  26. A

    Wiki HIGH Risk MDM for IV Morphine in the ED (discharged, not admitted)

    Pt presents to the ED with hand pain. ED provider orders Xray which confirms fractured metacarpal. Provider performs a closed reduction/splint application with no documentation of the patient having to f-u with an ortho for additional casting. Gives the patient IV Morphine and IM Diazepam "FOR...
  27. G

    Wiki MDM Sufficient?

    One of the physicians I code for has very minimal progress notes. They're generally follow ups for a broken bone or injury. He usually has 1 HPI point, no ROS and no Physical Exam. For the MDM (assessment), he writes: F/U (follow up) or F/U in 3 weeks. That is it, nothing else. Is this enough...
  28. C

    Wiki Help please! Transferred patient MDM

    Please help ASAP. Patient seen in ER and transferred to another facility. What is the Management Options to determine the MDM of this? Is it moderate like an IP/OP Admit or does it rate a High? Thanks in advance!
  29. J

    Wiki Sore Throat MDM

    Hello friends, I am having a struggle with the MDM on a sore throat, and I am seeing this increasingly on documentation, and even my providers are divided on this subject. A patient comes in, diagnosed with sore throat, are basically told it will run its course, rest and salt water gargles are...
  30. D

    Wiki 99221 or 99223????/Neuro Inp Consult

    HPI comp PFSH Comp ROS Comp Exam GA no acute distress HEENT mucus membranes moist, no conjunctival injection Fundoscopic exam-optic disc sharp on L, unable to see R CARDIO carotids-no bruit Heart-regular rate and rhythm+cardiac friction rub, no murmurs or...
  31. T

    Wiki Data Points for Soft Read X-rays

    Hello everyone! I work for a PCP office and there's a little confusion about how to count MDM data points for a soft-read of an x-ray. Should we count 1 point for the order and 2 points for the review? Or do we not count the review since it's a soft-read (another facility does the final review...
  32. M

    Wiki Medical Decision Making for Inpatient Psychiatry

    :confused: I have been searching and searching for guidance relating to the MDM for Psychiatry. The MDM that works for all other specialties doesn't really fit for Psychiatry. Example: New problem w/ work-up?? Yes, it's possible that there could be work-up but for the physician's that I work for...
  33. J

    Wiki OB visits for medicaid patients

    what do you bill for a OB visit for a patient with no complications. do you use the ACOG prenatal flowsheet? Currently we bill a 99213 but I am questioning the MDM if the patient is having no complications?
  34. T

    Wiki ED E&M code please help

    emergency room visit with a problem focused history comprehensive exam and MDM of high complexity would the code become a 99283 or 99284
  35. T

    Wiki E & M coding help please

    Please help with correct E&M code new patient office visit an expanded problem focused history, comprehensive exam MDM of high complexity what will the E & M code become
  36. K

    Wiki Billing out E&M level for Nurse Educator

    We are questioning if our Nurse Educator can bill out 99214 if she is not doing the Exam component and she would only be one area of the MDM. She is spending 45-60 minutes with each patient. Thank you
  37. D

    Wiki Resource

    I still get confused sometimes when trying to determine level of service for an E/M. Is there a good resource book out there that helps in explaining/clarifying E&M coding? Determining the # of diagnosis, level of MDM is so confusing sometimes, it would be helpful to have a good resource that...
  38. kfrycpc

    Wiki Determining A Consult Level

    Hi all, I'm a little confused when it comes to determine the level for a consult and also for inpatient. For a consult, I know 3 of 3 have to be met. If you have a C History , C Exam and H MDM, what would the level be? For an inpatient, I know 3 of 3 must be met. But if they are not, and say...
  39. D

    Wiki Referrals and MDM - I work for an urgent care

    Good Afternoon, I work for an urgent care organization and we average roughly 60 referrals per day. I reviewed the CMS 2014 E&M guidelines and under the MDM section for "Number of Diagnoses and/or Management Options": If referrals are made, consultations requested, or advice sought, the...
  40. A

    Wiki Ordering and interpreting xray-double dipping????

    If my physician orders an xray(1 point), performs and interprets the xray(2 points), can he get credit for three points in the MDM? I have read in several different places that this is considered double dipping if he gets paid the professional fee for interpretation as well as getting the two...