Wiki MDM

afryberger

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Hello Fellow Coders- I have a question for you because this is a discussion between coders. Under the decision making section of the E&M it gets broke down into three parts-Diagnosis, Data, and Risk. I was always told you need to have two out of the three to get your decision making and you move down the scale until you get your highest two. So for example if they have Low under diagnosis, moderate under data and high under risk. You would get a moderate for the overall MDM. You would choose your highest two. Another coder believes on a weight system, which i never heard of, that risk is higher than data on the weight system, that this would be a high under the MDM. I have never heard of that. If anyone has anything about a weight system or about risk being weighted more than Data, that would be great because the only thing I see is in the guidelines. Thanks in advance. :)
 
Good morning!

Per CMS E/M guidelines:

"Medical decision making refers to the complexity of establishing a diagnosis and/or selecting a management option, which is determined by considering these factors:
  • The number of possible diagnoses and/or the number of management options that must be considered:
  • The amount and/or complexity of medical records, diagnostic tests, and/or other information that must be obtained, reviewed, and analyzed
  • The risk of significant complications, morbidity, and/or mortality as well as comorbidities associated with the patient’s presenting problem(s), the diagnostic procedure(s), and/or the possible management options
This table depicts the elements for each level of medical decision making. Note that to qualify for a given type of medical decision making, two of the three elements must either be met or exceeded."

According to these guidelines you are spot on. I have never heard of a weighted MDM system, but would gladly review any trusted references.
 
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