• If this is your first visit, be sure to check out the FAQ & read the forum rules. To view all forums, post or create a new thread, you must be an AAPC Member. If you are a member and have already registered for member area and forum access, you can log in by clicking here. If you've forgotten the password it can be reset on our sign in section by entering your registered Email Address or Username here. To start viewing messages, select the forum that you want to visit from the selection below..

Wiki OIG suggestion for choosing E/M level

Create Wiki
G

gfarrell

Contributor
Messages
11
Location
Queen Creek, AZ
Best answers
0
I have heard the the OIG is strongly suggesting how to choose an E/M level. We already know that the AMA / CPT state an established patient only needs 2 out of the 3 components to meet the E/M level. I understand that the OIG is suggesting/weighing more on the MDM component and that they "strongly suggest" that the MDM should be one of the 2 components to declare the E/M level. I want to bring this info to my provider but I know he will want hard fast documentation and I cannot find it on the OIG website. Can anyone provide me with the link to a current document from the OIG about this? Your help is greatly appreciated! :confused:
 
I have not seen anything about this from the OIG. However, I agree that the MDM should be a driving factor in choosing a code. This relates back to the reason the patient is there or the 'Nature of the Presenting Problem'. For an E&M visit, it is legal to use the Hx and Ex but then I would question whether the medical necessity drives the actual code. Almost every insurance company indicates in the contract that you will only perform medical necessary services to the members - hence that can somewhat be directed to MDM - but not in all circumstances.
 
Not just the OIG...

CMS has previously stated for awhile that documentation alone shouldn't drive the selection of an E&M code, only support it.

"Medical necessity of a service is the overarching criterion for payment in addition to the individual requirements of a CPT code." (see CMS Claims Processing Manual, section 30.6.1 - Selection of Level of Evaluation and Management Service, Rev. 2373, 12-21-11) https://www.cms.gov/manuals/downloads/clm104c12.pdf

The OIG position is due to the realistic fear of automatic overcoding with 'point & click' and 'cut & paste' EHR's.
 
Anthem Blue Cross of CT updated their documentation guidelines effective 12/1/11. They now require MDM as one of the two components to determine the E/M level for established patients. I wouldn't be surprised if others start doing the same thing.
 
You must log in or register to reply here.
Top