E/M experts pleeeeeeeeeeeease.

daniel

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Say we have a case of bronchitis or even pharyngitis, dealing with an (establish patient). And are HPI is met for a level 4 and are ROS is met for a level 4. Then are exam is met also for a level 4. And the physician injects a shot of Rocephin. Does this administration count, as a prescription of drug management. Meaning would this count as a Moderate MDM. Curious to see what the coding world see's. If yes. Would you pull a level 4 out of this.

Even if the exam is not met.

Daniel
CPC
 

scottshar

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MDM most important key component

I've been taught by 3M and other consultants that MDM needs to be one of the 2 out of 3 key components at or above the level of service they are coding for. If you do not audit this way, then the providers can very easily get away with a detailed hx and exam on a common cold for example and attempt to call it a level 4. This would be over-coding based on the nature of presenting illness and probably minimal MDM required such as symptomatic or comfort care given. Unless there are add'l dx being tx'd or some indication that the visit is taking much more gray matter to determine etiology, severity, etc., then I would not give it to them. My President-Elect and all of my other chapter officers agree.
 

rthames052006

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I've been taught by 3M and other consultants that MDM needs to be one of the 2 out of 3 key components at or above the level of service they are coding for. If you do not audit this way, then the providers can very easily get away with a detailed hx and exam on a common cold for example and attempt to call it a level 4. This would be over-coding based on the nature of presenting illness and probably minimal MDM required such as symptomatic or comfort care given. Unless there are add'l dx being tx'd or some indication that the visit is taking much more gray matter to determine etiology, severity, etc., then I would not give it to them. My President-Elect and all of my other chapter officers agree.
Basically you would just use medical necessity as the driver in these cases, I agree that some providers try to get off with billing level 4 ov's for bronchitis, common cold, when ever I see it on my physicians I tell them that it wasn't medically necessary and in my cases it's been the exam thats "beefed" up so to speak.

I will use whatever 2 of the 3 key components, just beware of medical necessity.
 

daniel

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Thank You to all, who responded. I was on the fence with this one. Seems to me you have to deal with this on a case to case basis. Not just jump the gun, and say all are level fours.

Daniel
CPC
 
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