Wiki Mdm

[pdciaralli]

I was in Jacksonville for the conference one of the E/M presentations. We were told if a provider does an EKG and X-Ray he/she ordered the test, did the test and then read the EKG and X-Ray. We were told for the MDM it is two points for each if they do not code the EKG or X-Ray.
Last week the webinar on E&M in the ED the questions and answers it says you get 6 points for the same as above. 1 point for ordering and 2 for preforming and reading.
Does anyone know which one is correct?
Paula Ciaralli, CPC

 

[Pam Warren]

Based on our local carrier, NHIC (and consultants working in New England), neither is correct. You would get only one point each for ordering and reviewing the lab and rad under your data review. Even though the description of that data point is "review or order", we've been advised to allow only one point when you order and subsequently review results. And you definitely cannot get the points if you are going to also bill the professional component for the interpretation and report. The two additional points for "independent visualization of image, tracing, or specimen" is only if you are reviewing someone else's ordered diagnostics. NHIC's E&M audit tool specifically says "not simply review of the paper copy report".


I wonder if other carriers have a different interpretation? This is a great example of how different consultants give us information that isn't clearly outlined in regulatory guidance, and also how payers and regions differ in their E&M guidelines. Gotta love it!