Help with MDM data points

dballard2004

True Blue
Messages
1,171
Location
Overland Park, KS
Best answers
0
This question has been asked before, but I need someone to further clarify this for me please.........

Under the MDM part of the an audit under the Amount and/or Complexity of Data Reviewed, if the provider ordered and/or reviewed an x-ray, then one point is assigned. If there is an indepenedent visualization of image, tracing, or specimen (not simply review of report), then 2 points are assigned. Does this mean that if the provider orders an x-ray and then documents that he/she independently reviewed the film that a total of 3 points are assigned? Would this not be considered douple-dipping? I was always under the impression that in order to recieve the two points for the independent review the provider had to perform the x-ray themselves and own the equipment.

Can someone please clarify this for me and provide me with the guidelines that explains the correct way to assign the points for this? I have a provider who is questioning an audit and thinks that she should recieve three points because she ordered the x-ray and then looked at the film. Any insight is appreciated. Thanks so very much.
 

coder5254

Contributor
Messages
21
Location
Lakeland
Best answers
0
Mdm

under MDM if physician read report and interpreted film, I would give 3 points credit...1 for read report, 2 for interpretation. I use an audit sheet that breaks all this down which is helpful when counting bullet points
 

dmaec

True Blue
Messages
1,133
Location
Hibbing, Minnesota
Best answers
0
Dawson,
this is from E/M University website.
"You can get two data points if you personally review an image, tracing or specimen. It does not matter if there is an official report already in the record (for example an official interpretation from a radiologist for a chest X-ray). All that is required is that you personally eye-ball the image, tracing or specimen AND record YOUR findings in the chart."

http://emuniversity.com/MedicalDecision-Making.html
http://emuniversity.com/PointsforReviewofImageorTracing.html
 

renifejn

Guru
Messages
208
Best answers
0
sorry if that has already but answered but i just need clarification once again:

Example

Cardiologist states results of EKG in office visit note and also bills for this service.

...so being is an office visit with and EKG by the same provider---in the data points section is the provider getting 1 point? 2 points? or no points because they are already billing for the service and that'd be double-dipping?
 

dmaec

True Blue
Messages
1,133
Location
Hibbing, Minnesota
Best answers
0
renifejn,
The provider must document independent visualization of an image, tracing or specimen in order to count 2 points.
If the provider separately bills for the independent visualization (e.g. prepares a written report for an X-ray), do not count this for purposes of Data Reviewed as the provider is receiving separate reimbursement for this service.
{that's my opinion on the posted matter}
 
Top