marleee
New
Hello!
Our center is concerned about our E/M levels, medical necessity in particular. As long as I can remember, medical necessity was derived from calculation of the MDM, but we have an extraordinarily low level of 3s vs. 2s and 4s for our ED visits. So we do not have that nice bell curve, but rather something that emulates an "M" (with the peaks at levels 2 and 4). Since then I have been trying to find something that states not only do we calculate medical necessity using CMS' audit tool to calculate the MDM, but we need to follow CPT/AMA guidelines that also state the severity of the presenting problem need be of a certain severity before selecting a level of service as well.
Does anyone have any input; agree, disagree?
As a coder it is fairly hard to say this certain problem is of moderate severity vs. that problem is high severity...unless the provider provide the coder with the severity. I think this severity should be part of the plan vs. part of HPI's severity as the HPI is the what the patient is feeling verses the provider's opinion.
I appreciate any help on this difficult subject!
Our center is concerned about our E/M levels, medical necessity in particular. As long as I can remember, medical necessity was derived from calculation of the MDM, but we have an extraordinarily low level of 3s vs. 2s and 4s for our ED visits. So we do not have that nice bell curve, but rather something that emulates an "M" (with the peaks at levels 2 and 4). Since then I have been trying to find something that states not only do we calculate medical necessity using CMS' audit tool to calculate the MDM, but we need to follow CPT/AMA guidelines that also state the severity of the presenting problem need be of a certain severity before selecting a level of service as well.
Does anyone have any input; agree, disagree?
As a coder it is fairly hard to say this certain problem is of moderate severity vs. that problem is high severity...unless the provider provide the coder with the severity. I think this severity should be part of the plan vs. part of HPI's severity as the HPI is the what the patient is feeling verses the provider's opinion.
I appreciate any help on this difficult subject!