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New Problem to examining MD: Additional Work-up versus No Additional Work-up

jennimeich@gmail.com

New
Local Chapter Officer
Messages
2
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0
Hi! I am a new CPC-A working on the Practicode. I am using the E/M Audit Tool to assign points for MDM. I am also using tools from E/M University. A lot of the cases I am working through are in the ED. I am missing the mark on leveling - I just coded 2 practice cases in a row that I should have coded 99285, but I thought they were 4s. If the examining doctor is discharging a patient because they are stable but advising them to make the next available appointment with a specialist or other physician, is this considered a New Problem with Additional Work Up Planned since the physician is counseling them to see another physician? I thought it was No Additional Work up Planned because the patient was being discharged. Thanks in advance. E/M leveling is a learning process for me :).
 

thomas7331

True Blue
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1,970
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'Additional work-up' is sort of industry lingo for additional diagnostic testing or evaluation by specialists that is needed in order to confirm a diagnosis. If a provider is not able to diagnose and/or complete a treatment plan with the information obtained during the encounter and additional tests are needed, or input from a specialist is required, that translates into uncertainty which makes the MDM more complex than if the provider can make a definitive diagnosis and write all the necessary orders and recommendations. So referring to a specialist for evaluation, in a general sense, would usually qualify for this. The fact that the patient is stable and discharged does make the MDM lower in the risk category, but that is independent of the diagnosis points.

On a side-note, I also went through the E/M University tools when I initially needed additional E&M training and it's a great program and largely right on the mark, but I would just add a word of caution that being from the perspective of a physician, it is quite aggressive with the levels and interpretation of how to count points. I've found that in the real world, some payers and auditors wouldn't necessarily agree with everything in there, especially when it comes to those highest level visits, and there has been a shift in recent years to requiring the severity of the illness to support the high level codes, not just the points counted.
 
Last edited:

jennimeich@gmail.com

New
Local Chapter Officer
Messages
2
Best answers
0
'Additional work-up' is sort of industry lingo for additional diagnostic testing or evaluation by specialists that is needed in order to confirm a diagnosis. If a provider is not able to diagnose and/or complete a treatment plan with the information obtained during the encounter and additional tests are needed, or input from a specialist is required, that translates into uncertainty which makes the MDM more complex than if the provider can make a definitive diagnosis and write all the necessary orders and recommendations. So referring to a specialist for evaluation, in a general sense, would usually qualify for this. The fact that the patient is stable and discharged does make the MDM lower in the risk category, but that is independent of the diagnosis points.

On a side-note, I also went through the E/M University tools when I initially needed additional E&M training and it's a great program and largely right on the mark, but I would just add a word of caution that being from the perspective of a physician, it is quite aggressive with the levels and interpretation of how to count points. I've found that in the real world, some payers and auditors wouldn't necessarily agree with everything in there, especially when it comes to those highest level visits, and there has been a shift in recent years to requiring the severity of the illness to support the high level codes, not just the points counted.
Thomas, thank you so much for sharing your insight! I really appreciate it. I have read that E/M may see significant changes in 2019; it will be interesting to see what 2019 holds for E/M. Thanks again for taking the time to respond.
 
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