Wiki Need help with mdm!!

[taurus7694]

I am a CPC for an Orthopedic office. The coders have been told that we will now be auditing E/M levels to help educate our physicians. We are very confused about the 1997 guidelines in regards to the MDM-Amount and/or Complexity of Data Reviewed section.

Our physicians see a patient and the majority of the time an xray is ordered, taken in the office, and reviewed (visualized) that day in the office by the physician himself.

Our question is: How do we score this in the Data section? Do we give them 1 pt for "review and/or order tests in radiology section" and 2 pts for "Independent visualization of image..not just reviewing the report" for a total of 3 pts.

OR

Do we only give them 1 pt for the "review and/or order tests in radiology section" ??

Does "independent visualization of image...not just review of report" only count if the physician pulls up an image that was taken in the ER days prior to the patient's visit or if the patient brings in a CD of an MRI obtained at another site??

any help with this will be greatly appreciated

 

[btadlock1]

I am a CPC for an Orthopedic office. The coders have been told that we will now be auditing E/M levels to help educate our physicians. We are very confused about the 1997 guidelines in regards to the MDM-Amount and/or Complexity of Data Reviewed section.

Our physicians see a patient and the majority of the time an xray is ordered, taken in the office, and reviewed (visualized) that day in the office by the physician himself.

Our question is: How do we score this in the Data section? Do we give them 1 pt for "review and/or order tests in radiology section" and 2 pts for "Independent visualization of image..not just reviewing the report" for a total of 3 pts.

OR

Do we only give them 1 pt for the "review and/or order tests in radiology section" ??

Does "independent visualization of image...not just review of report" only count if the physician pulls up an image that was taken in the ER days prior to the patient's visit or if the patient brings in a CD of an MRI obtained at another site??

any help with this will be greatly appreciated

Did the physician bill separately for interpreting the radiology report (eg, did you bill it without a TC or 26 modifier)? If so, then give it 1 point. If not, give it 2. The "and/or" tells you that they get 1 point for the test, whether they ordered it, reviewed it, or did both. Independent visulaization gets an extra point, because the doctor has to do more work than he would, if a radiologist had reviewed it and made a report for them to confirm.

 

[melzinser]

That's correct, Brandi. The "credit" for reviewing/intyerpreting the in-house imaging study is included in the global charge/reimbursement. Giving two points would amount to "double-dipping."

 

[mdoyle53]

The ortho office is where the physician actually interprets the xray and hence the MDM would qualify for 2 in the data section (if the MD is not interpreting, then it would only be a 1 in the data section).

 

[FTessaBartels]

Are you billing for the Xray?

If you are billing for the Xray (it was done with your equipment), then you are already being reimbursed for that and should not claim the extra point to boost your data points (and possibly increase your level of E/M)

Our surgeons work out of a hospital clinic. The HOSPITAL owns/operates the x-ray equipment. The surgeons are NOT employed by the hospital, so their practice is a separate tax entity. Okay ... that sets the scene for you. The surgeons will almost always pull up the "film" to independently review it, and not just rely on the radiologist's report. In these cases the surgeon will get 2 data points for independent visualization (IF s/he so documents). If there is no documentation of independent visualization, the surgeon gets only 1 data point for ordering the x-ray (or ultrasound or whatever)

Hope that helps.

F Tessa Bartels, CPC, CEMC