Data in MDM

stpat

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On the Data reviewed in MDM, labs and xrays count as one point regardless of the number ordered and/or reviewed. But the Medicine section (90701-99199) does not state that stipulation so I have always counted multiples when the doc orders or reviews items from the medicine section. For example, if he reviews an echo and orders a cath, I would give 2 points in the Medicine section. We have a difference of opinion on this in our office. Is there any definitive literature on this out there anywhere?
 

kibdog

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My understanding of &M auditing would be that you are only able to count it once regardless of how many tests are reviewed from the Medicine section or any other section. The only time that you would get more than 1 point in the Reviewed Data section of E&M, (eg. 2 points) would be if the physician reviewed old records.

Hope that helps!
 

kibdog

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My understanding of E&M auditing would be that you are only able to count it once regardless of how many tests are reviewed from the Medicine section or any other section. The only time that you would get more than 1 point in the Reviewed Data section of E&M, (eg. 2 points) would be if the physician reviewed old records.

Hope that helps!
 

kcsmagic

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I perform the audits on our doctors for the practise im with and a helpful tool would be to use the pocket reference on the Trailblazer Website for Medicare. It has guidelines to show what may be counted as more than one point. From what I have read it needs to be greater than 4 ordered to count as 2 points. Here is the link to the pocket reference tool. I hope it helps. :)

http://www.trailblazerhealth.com/Publications/Job Aid/coding pocket reference.pdf
 
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Milwaukee WI
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Carrier specific guidelines

Be careful of carrier specific guidelines, if that is not YOUR carrier. CMS does allow the individual carriers to "clarify" the guidelines. (For example: One carrier might allow "all others reviewed and negative" for ROS; another might require that each system be specifically stated positive or negative.)

That being said ..

My copy of the 1995 and 1997 guidelines state:
Review and/or order of clinical lab tests - 1 point
Review and/or order of tests in radiology section of CPT - 1 point
Review and/or order of tests in the medicine section of CPT - 1 point
Indepent visualization of image, tracing or specimen itself (not simply review of report) - 2 points

So to answer your basic question, mkarnes, I'd only give 1 point for however many tests in the medicine section were either ordered or reviewed. I'd give TWO points if the physician performed/interepreted the test him/herself.

F Tessa Bartels, CPC, CPC-E/M
 
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