Wiki MDM Help!!!

[ajballard]

My doctor is an orthopedic surgeon, and he is seeing an established patient. The visit has a Comprehensive History, and Detailed physical exam. After reviewing an X-Ray it was determined the patient needed surgery. The plan is to do a diagnostic arthroscopy with synovial biopsy and possibly a major synovectomy.

Since I am new at auditing, I understand that since surgery is scheduled the Management Options under the MDM would be Moderate. Is this correct?

The doctor billed out a 99213 with a MDM of low. But since surgery was scheduled, would it be moderate or low? Any help on this would be greatly appreciated.

Thanks!
Amanda

 

[chasarmil]

There are 3 components that make up the MDM.
1. is the # diagnosis or treatment options - was this an established problem to the provider or a new problem?
2. is the amount of data
3. is the risk - and this would be moderate since he decided to do surgery.

It could be that it was an established problem to the provider and reviewed 1 lab/data
and even though the risk was moderate, those 2 components could bring the MDM to low.

 

[LLovett]

Established patients are 2 of 3. Based on a comp history and detailed exam this could be a 99214 as long as it was medically necessary.

As to MDM, it is also 2 of 3. Your risk would be moderate but how many diagnosis and data points do you have?

Clearly you should have at least 2 diagnosis and 1 data point, but if that is all you have you would be stuck at low for MDM. Which may be why the provider went with a 99213 to start with.

On a side note, I'm surprised that an ortho did 10+ ROS on an established patient.

Laura, CPC, CPMA, CPC-I, CANPC, CEMC