lajames
New
If a physician orders an outside lab, does the visit get coded up a level? I thought labs ordered just gave one point towards MDM on the score sheet.
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Wiki E&M
- Thread starter lajames
- Start date
Pathos
Guest
Short answer: Maybe.
The E/M code level always depends on medical necessity and documentation, and as such you would need to take all E/M components into consideration (History, Examination, Medical Decision Making). Based on the single lab point (or perhaps two if "Independently reviewed" with proper documentation) alone, I would probably say no as Medical Decision Making is just one of the three factors which determine the E/M level, and the Amount and Complexity of Data is also one of the three components which make up the Medical Decision Making (under the Marshfield Clinic Tool). Some quick pointers for E/M auditing:
-Determine New vs. Established
-What is the History level (95 or 97 guidelines)
-What is the Examination level (95 or 97 guidelines, stay with same guidelines as History)
-What about the rest of the Medical Decision Making (Diagnosis and/or Management Options, any other Data, Total Risk)
Make sure you have all of the pieces before making an E/M level determination, otherwise you will most likely miscode the visit.
Sources:
CMS E/M guidelines MLN
Novitas E/M guidelines (MAC)
EM University E/M - Medical Decision Making
The E/M code level always depends on medical necessity and documentation, and as such you would need to take all E/M components into consideration (History, Examination, Medical Decision Making). Based on the single lab point (or perhaps two if "Independently reviewed" with proper documentation) alone, I would probably say no as Medical Decision Making is just one of the three factors which determine the E/M level, and the Amount and Complexity of Data is also one of the three components which make up the Medical Decision Making (under the Marshfield Clinic Tool). Some quick pointers for E/M auditing:
-Determine New vs. Established
-What is the History level (95 or 97 guidelines)
-What is the Examination level (95 or 97 guidelines, stay with same guidelines as History)
-What about the rest of the Medical Decision Making (Diagnosis and/or Management Options, any other Data, Total Risk)
Make sure you have all of the pieces before making an E/M level determination, otherwise you will most likely miscode the visit.
Sources:
CMS E/M guidelines MLN
Novitas E/M guidelines (MAC)
EM University E/M - Medical Decision Making