1. KStaten

    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...
  2. KStaten

    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!) -------------------------------------------------------------------------------------------------------------------------...
  3. J

    Question 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...
  4. KStaten

    Question 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...
  5. W


    Hello Everyone, Quick MDM question, what level would you go with. Patient had 2 days of left side facial pain. Patient stating he is using motrin which somewhat manages pain. Patient denied cough, fevers and no sick contacts. Discomfort 3 out of 10. First visit of complaint. Multiple...
  6. KStaten

    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...
  7. S

    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...
  8. KStaten

    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...
  9. S

    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
  10. K

    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...
  11. C

    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...
  12. J

    ED Profee rx management

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

    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...
  14. A

    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...
  15. A

    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...
  16. G

    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...
  17. C

    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!
  18. J

    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...
  19. D

    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...
  20. T

    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...
  21. M

    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...
  22. J

    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?
  23. T

    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
  24. T

    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
  25. K

    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
  26. D


    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...
  27. kfrycpc

    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...
  28. D

    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...
  29. A

    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...