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Wiki 2 out of the 3

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KaylaRieken

True Blue
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Waukee, IA
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Can I ask what other offices are doing about the 2 out of the 3? History, Exam, and MDM. It's so easy these days with EMRs to get comprehensive History and Exams. Are any of you using MDM as one of the 2 out of the 3? My providers are hitting comprehensive history and exams on every patient they see.
 
Coding for E&M's can be confusing in this new world of EMR/EHR. Most studies are showing an increase in the leveling of E&M's since we switched to EMR's as it is so much easier to hit all of the points needed to level higher. In these cases CMS reminds us that the final determination comes down to medical necessity. Using MDM as one of the levels is a good barometer for determining medical necessity.

  • If the patient is coming in for a recheck on a resolved ear infection and is leveling at a 99214, then from the medical necessity would not meet the 99214 level of care.

These become grey area for us coders as we rely on the point system to keep us on the straight and narrow. This may be an opportunity to review the documentation with your provider in relationship to medical necessity and make sure you understand their intent in the additional documentation. It may be the way the EMR is set or the provider may have a different point of view on medical necessity. It is a great opportunity to learn from each other.
 
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