Wiki Double Dipping? Section B of MDM

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ljmcnamara3

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Hi everyone! Quick question....

If a provider is ordering an Ultrasound, then also doing the interpretation....do you give 3 points in Section B of MDM? The provider also bills for the Ultrasound. I am thinking 1 point only for the order because he is reimbursed for the interpretation through the CPT.

Please help! :eek:
 
ljmcnamara3 said:
Hi everyone! Quick question....

If a provider is ordering an Ultrasound, then also doing the interpretation....do you give 3 points in Section B of MDM? The provider also bills for the Ultrasound. I am thinking 1 point only for the order because he is reimbursed for the interpretation through the CPT.

Please help! :eek:
Click to expand...


Are you reporting an E/M with the radiology code?
Was the ultrasound performed in the office?
 
I agree with you. If they order, and also interpret, I'd only give the single point. You're correct; they're being reimbursed for professional interpretation of the US, so to also count it as an additional data point constitutes double dipping. Same for doing EKGs in the office....one point only for ordering in the data section of MDM, then 93000 for the test/interpretation global code.

Not all auditors go along with this, but I tend to be more conservative. I also consider the nature of the presenting problem, from an overall complexity standpoint. Often that's more telling than all the bullet-counting.
 
No double dipping - but I give two

While I agree with not giving three data points, unlike Pam, I have given two points for the interpretation as that does take a little more skill and I will give credit fot this, especially if the interpretation leads to an action in the treatment plan. Using the EKG example, if there is further cardiac workup or a medication prescribed as a result of the physician's interpretation, then I will give the two points. I get the argument Pam uses for one point - but also there are times I am not seeing whether the EKG is being billed or not (I hope so, but from just reading the progress note, I won't know this) so in those cases, I certainly will give the two data points.
 
Source material?

Thanks, everyone! Yes, the Provider will be billing for an E/M as well as the Ultrasound. So I found this: http://www.aafp.org/fpm/2010/0700/p10.html#fpm20100700p10-ut2
Your "direct visualization and independent interpretation of an image, tracing or specimen" that has been or will be interpreted by another physician. Again, the guidelines suggest that such independent checking is not expected to be a regular thing, but rather something that happens only "on occasion."

I just need something more concrete to bring to the Provider. Pam - I'm in total agreement with you - just need a source document....
 
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I did agree with what Pam before! I had always been told from various sources that if you are billing for the interp you can't claim 2 data points for the inter. Then I read an article by Jim Collins stating that he contacted CMS and was informed that you could claim both for the ordering and for the interp of an EKG. So, I decided to contact CMS myself and below is the response I received:

This e-mail is being sent in response to your inquiry received in our office on November 3, 2014, attached below. Your request pertains to clarification of medical decision making (MDM).

In researching your request, contact was made with our Comprehensive Error Rate Testing (CERT) Department. They have indicated that you can obtain points for the order and the independent viewing. They have also confirmed that if the same doctor is billing for the EKG and interpretation, he can also obtain points for the data. They have also agreed that if the provider owns the machine that performs the EKG and only bills for the EKG report that he can obtain points for the order and the individual review. However, there must be clear documentation that the physician ordered and independently interpreted the EKG. It is not sufficient to use the printed interpretation on the EKG printout.

I hope the information I have provided is helpful. If you have any questions regarding this inquiry, you may contact me directly at 904-791-6147. If you have general questions, you should contact a member of our Provider Contact Center (PCC) at 866-454-9007.

Sincerely,


Maureen Pickering
Provider Relations Research Specialist (PRRS)
Medicare Customer Service Center
?Where Experience Counts & Quality Matters?

So, I still do feel that 2 points should not be given if they are also billing for the EKG, but according to Medicare - this is acceptable!

Hope this helps! Or doesnt' confuse you more - like it did for me! :D
 
Wow, Jodi! That does clear things up! I agree with you though, really feel weird about giving the 2 points.... Well, the provider will certainly be happy about this!!!
 
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