Wiki Skin testing, low or moderate risk

[shollis]

Hello! Need help in settling a debate on if skin testing would be considered a low or moderate risk test when it comes to MDM as we're not finding concrete evidence to support either one. For instance, new patient comes in with complaints of rash, year long sinus congestion, coughing, swollen hands after contact with shellfish, etc. Provider decides to do a skin test same day. Would the test be considered "other low risk testing or treatment" or "Other moderate risk testing or treatment" when we're choosing the diagnostic procedure risk level on the 2023 E/M MDM calculator? Most times, this option can change the E/M level from a level 3 to a level 4 depending on the opinionated risk. I welcome any insight. Thanks

 

[jkyles]

Hi there,

The treating provider must indicate the level of risk if you're coding based on MDM. From an FAQ by the AMA: https://www.ama-assn.org/practice-management/cpt/cpt-evaluation-and-management-em-revisions-faqs

As a result, the physician's documentation of his or her level-of-risk assessment based on the specific patient's risk factors is the determining component in how the MDM level of risk for the specific patient will be calculated.

 

[shollis]

Hi there,

The treating provider must indicate the level of risk if you're coding based on MDM. From an FAQ by the AMA: https://www.ama-assn.org/practice-management/cpt/cpt-evaluation-and-management-em-revisions-faqs

Thank you!