Wiki 2021 Determining MDM for exam with procedures

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LauraB

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Hi, I code for Dermatology clinic visits & have a 2021 E&M question. I know the data part of MDM talks about labs and tests not being counted towards the MDM level if you are billing for them. But how does that compare for encounters where you are billing an exam and procedure(s)?

For a generic example, pt comes in for a skin check and they also have a bump bothering them on the left hand. The doctor finds several minor issues during the skin check, decides to shave off the hand bump as treatment & also biopsy a suspicious spot on the back.

Since you are separately billing a CPT for the 11305 and 11102, can you count those when figuring your MDM - towards either your Data or Risk elements? I’ve tried researching for this and any actual examples, but all I seem to find is info on tests & labs and not actual Procedures. Any information is greatly appreciated!! Thank you in advance!
Laura
 
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LauraB said:
Hi, I code for Dermatology clinic visits & have a 2021 E&M question. I know the data part of MDM talks about labs and tests not being counted towards the MDM level if you are billing for them. But how does that compare for encounters where you are billing an exam and procedure(s)?

For a generic example, pt comes in for a skin check and they also have a bump bothering them on the left hand. The doctor finds several minor issues during the skin check, decides to shave off the hand bump as treatment & also biopsy a suspicious spot on the back.

Since you are separately billing a CPT for the 11305 and 11102, can you count those when figuring your MDM - towards either your Data or Risk elements? I’ve tried researching for this and any actual examples, but all I seem to find is info on tests & labs and not actual Procedures. Any information is greatly appreciated!! Thank you in advance!
Laura
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I have the same question. Have you found any answers.
 
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I, personally, would not since you have already billed for them. If you include them in the E/M, that could be considered as 'double-dipping'.
 
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Hmm .. upon re-thinking what I'd said and re-reading the question, I now think that you can include it in the E/M. I believe that I was confusing it with data where you can often get an independent interpretation and report with one of the relevant CPT codes included in the data being gathered when you bill for it.
 
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