Jfraska
Contributor
I have been going through some confusion regarding these data points and now I am trying to defend my case to my Drs
There are 2 criteria under the amount and/or complexity of date reviewed portion of MDM. This is what it says on the chart I was given, word for word
"Decision to obtain old records and/or obtain history from someone other than the patient" - 1 pt
"Review and summation of old records and/or obtaining history from someone other than the patient and/or discussion of case with another health care provider" - 2pts
The issue is when a Dr documents this-
"He is accompanied by his mother, who helps provide the history. I have reviewed all records available to me"
To me, this falls under the category which would give them 2 points. They do go on and summarize the patient's history along with what the parent provides. (I work in a children's hospital by the way)
The Drs have been arguing that they should receive 3 pts for reviewing and obtaining info from the parents. Based on what the chart I use says, it clearly states that reveiwing/summarizing records and obtaining info from someone else is under one umbrella and gets 2 pts. The other point is only when the provider MAKES the decision to obtain records/obtain history from someone that they do not have already. Drs think they can use the review/summaring as 2 and the obtain history from parent as 1. My manager and educator agree on this but it can vary by the notation of course. My manager argued that if the parent provides extra information that wasn't provided in the documents reviewed then they would indeed get 3 points. The information the parent provides has to be relevant of course and not just reporting current symptoms, but actual history.
I attached my chart (1) here as well as the chart the Dr said she was given as a tool (2)
View attachment Billing tool.pdf
Thanks for any feedback
Sometimes this isn't a huge deal but lately it's been the difference between a level 4 and 5 when the Dr wants that 5
There are 2 criteria under the amount and/or complexity of date reviewed portion of MDM. This is what it says on the chart I was given, word for word
"Decision to obtain old records and/or obtain history from someone other than the patient" - 1 pt
"Review and summation of old records and/or obtaining history from someone other than the patient and/or discussion of case with another health care provider" - 2pts
The issue is when a Dr documents this-
"He is accompanied by his mother, who helps provide the history. I have reviewed all records available to me"
To me, this falls under the category which would give them 2 points. They do go on and summarize the patient's history along with what the parent provides. (I work in a children's hospital by the way)
The Drs have been arguing that they should receive 3 pts for reviewing and obtaining info from the parents. Based on what the chart I use says, it clearly states that reveiwing/summarizing records and obtaining info from someone else is under one umbrella and gets 2 pts. The other point is only when the provider MAKES the decision to obtain records/obtain history from someone that they do not have already. Drs think they can use the review/summaring as 2 and the obtain history from parent as 1. My manager and educator agree on this but it can vary by the notation of course. My manager argued that if the parent provides extra information that wasn't provided in the documents reviewed then they would indeed get 3 points. The information the parent provides has to be relevant of course and not just reporting current symptoms, but actual history.
I attached my chart (1) here as well as the chart the Dr said she was given as a tool (2)
View attachment Billing tool.pdf
Thanks for any feedback
Sometimes this isn't a huge deal but lately it's been the difference between a level 4 and 5 when the Dr wants that 5