Clarification needed on new E/M changes

lhoot

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Good Afternoon,
Have the new changes to office and other outpatient visits combined the separate steps of calculating the diagnosis/management options, type of data and risk into one process? Currently, you will:
  • Determine the diagnosis and management options (sored with points)
  • Calculate the types and amount of data (scored with points)
  • Determine risk based on:
    • Presenting problem
    • Dx procedures ordered
    • Management Options Selected.
These are then placed in the rubric to determine the level.

With the new changes it looks like you will only use one rubric to:
  • Determine the number and complexity of problems addressed (similar to presenting problem in the risk table currently in place)
  • Determine amount and/or complexity of data to be reviewed and analyzed (similar to types and amount of data in step 2 above, but not using a point system)
  • Determine risk of complications and or morbidity or mortality of patient management (similar to management options selected in the risk table currently in place)
The positions of these elements in this one rubric determines the level.

To me, it looks like they have tweaked the table of risk a bit and are doing away with the first two steps. We will only need the one table now to determine MDM, is this correct?

Thanks,
Laura
 

Kristen Bensel

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Yes, we will have to rely on the new table of risk as the only tool for these codes- they have removed the HPI and Exam as requirements for leveling, but the providers still need to document these items to better fit the reason the patient is being seen rather than to hit a certain number of points. Unless the provider wants to use time- but the use of time for the level determination is tricky. I am trying to figure out a way to really explain to the providers that while it may sound easy to just slap a time statement in the note, it isn't that simple anymore.

In case you haven't seen the table from the AMA yet, here is a link to it.

 

csperoni

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Yes, we will have to rely on the new table of risk as the only tool for these codes- they have removed the HPI and Exam as requirements for leveling, but the providers still need to document these items to better fit the reason the patient is being seen rather than to hit a certain number of points. Unless the provider wants to use time- but the use of time for the level determination is tricky. I am trying to figure out a way to really explain to the providers that while it may sound easy to just slap a time statement in the note, it isn't that simple anymore.

In case you haven't seen the table from the AMA yet, here is a link to it.

I don't see this as only risk is evaluated to level visit. I still see this as complete MDM, of which risk is only 1 element. The AMA table specifies that MDM is still based on 2 of 3 elements of:
  • Number/complexity of problems
  • Amount/complexity of data
  • Risk/Morbidity
This looks to me very similar to the data for the MDM table now in use, but a little re-organized. I agree that the first step of the current MDM (diagnoses treated) is eliminated and replaced with problem from the current risk table. The data review is also reworded regarding unique tests and unique source.
 

Kristen Bensel

Networker
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Pilot rock, OR
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I don't see this as only risk is evaluated to level visit. I still see this as complete MDM, of which risk is only 1 element. The AMA table specifies that MDM is still based on 2 of 3 elements of:
  • Number/complexity of problems
  • Amount/complexity of data
  • Risk/Morbidity
This looks to me very similar to the data for the MDM table now in use, but a little re-organized. I agree that the first step of the current MDM (diagnoses treated) is eliminated and replaced with problem from the current risk table. The data review is also reworded regarding unique tests and unique source.
My apologies for my wording in my previous post- to me, the MDM tool the AMA provided for E/M selection starting in January looks like an updated and more organized version of the table of risk.
 

lhoot

Networker
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Yes, we will have to rely on the new table of risk as the only tool for these codes- they have removed the HPI and Exam as requirements for leveling, but the providers still need to document these items to better fit the reason the patient is being seen rather than to hit a certain number of points. Unless the provider wants to use time- but the use of time for the level determination is tricky. I am trying to figure out a way to really explain to the providers that while it may sound easy to just slap a time statement in the note, it isn't that simple anymore.

In case you haven't seen the table from the AMA yet, here is a link to it.

Kristen,
This is how I am understanding it, but from the discussion we are having it sounds like I'm not the only one who isn't completely sure.
Laura
 

lhoot

Networker
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I don't see this as only risk is evaluated to level visit. I still see this as complete MDM, of which risk is only 1 element. The AMA table specifies that MDM is still based on 2 of 3 elements of:
  • Number/complexity of problems
  • Amount/complexity of data
  • Risk/Morbidity
This looks to me very similar to the data for the MDM table now in use, but a little re-organized. I agree that the first step of the current MDM (diagnoses treated) is eliminated and replaced with problem from the current risk table. The data review is also reworded regarding unique tests and unique source.
Christine,
So, you understand this change to mean that the new table is simply a revision of the risk table. Calculating an E/M will be done pretty much like we do now, just instead we will use the new table for to replace the current risk table only and not use the new table as the sole reference for calculating MDM?

Laura
 

csperoni

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Christine,
So, you understand this change to mean that the new table is simply a revision of the risk table. Calculating an E/M will be done pretty much like we do now, just instead we will use the new table for to replace the current risk table only and not use the new table as the sole reference for calculating MDM?

Laura
No, to me this is a revision to the complete MDM, not just the risk table. Basically, throw out anything you were using before and use only the new MDM tool (which does happen to incorporate a lot of the previous risk table), or time.
 
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