Wiki Mdm

[CodingAuditor]

Can anyone point me in the right direction?

In the Understanding E/M Coding 2008, on page 34, second paragraph it says " where only two of the three of history, exam, and decision making are required, that one of those should be decision making."


Does anyone have ANY documentation on this.... other than this book? I e-mailed the AMA but have yet to hear back. if so can you please send me a link?

Thanks,
Danielle Erickson, CPC

 

[ARCPC9491]

This is a debatable topic and unfortunately I do not have any documentation on this.

In my personal opinion, MDM is the driver of the other two components, exam and history. I feel as if when providers are see a patient they should think backwards - determine the level of MDM first because in most instances in 10-15 seconds, they already know what they are going to do. After the MDM is established, they then may choose to do an exam or the history (if established patient) - whichever is pertinent or medically makes sense. This is their own clinical judgement. This way, you ensure medical necessity of the service.

To better put into prospective for your established patient, if you have a comprehensive history, comprehensive exam, and MDM of straightforward, I'm pretty sure the payers would have a problem if you coded 99215. This is why if you work backwards from the MDM, you can ensure the MDM matches the level of service.

Hope that makes sense!

 

[cdcpc]

Perfect example

ARCPC--do you mind if I copy your above answer and discuss this with my providers? The way you explained it really makes sense and I think this would be really helpful to them.
Thanks

 

[ARCPC9491]

Sure!