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E&M Data Points

  1. Default E&M Data Points
    Medical Coding Books
    Hope someone has the answer to my "Data" points questions and will be able to supply the appropriate references to support the answers.

    How many points would you get for visualization of an image (2), as well as reviewing the radiology report (1)?
    Would you actually get 3?
    When visualizing an image, with or without a report what documentation would you expect, besides the fact that the image was visualized and report reviewed?

    Thank you for your help. I very much appreciate it.
    Deb

    Deborah Peloso LPN, CPC, MCS-P, CHCA
    Stamford Health Integrated Practices
    1055 Summer St.
    Stamford, CT 06905
    (T) 203-276-2122
    dpeloso@shipmds.org

  2. #2
    Default
    I only give 2 points if the provider personally reviews the same film that he read the report on.
    Melissa Tescher, CPC, CPMA, CEMC Compliance and Coding Specialist
    Willamette Valley Professional Services member National Advisory Board 2013-2015

  3. #3
    Location
    Daytona Beach, FL
    Posts
    752
    Default
    Funny you should ask this question as I was asking the same or similar question in another thread, but did not get an answer. In your situation I would only give 2 points because it is the same test and that would be double dipping. Now, here is my question!

    I am having an issue with my physicians with this same issue about how to score the Data points and some information that they received from an outside "consultant".

    I am coding for cardiologists who do EKG's in the office. Originally they were billing the global 93000 for these, however after an audit it was apparent they were not documenting a separate interpretation for the EKG, so until this can be cleared up, they are only billing for the tracing.

    First, I was under the impression that if the physician is billing separately for the test, then they would not get any points under Data as they are receiving the reimbursement for the test. However the consultant states otherwise. Then, the consultant is stating that if the physician orders the EKG and also independently visualizes the test, they would get 3 points - 1 for ordering, 2 for the visualization. I believe I was told by Novitas during one of their E/M webinars that if they did the visualization then you would only assign the 2 points and also that if they were billing for the test, they would get no points for ordering or visualization. So how would you score the following for Data points:

    1. Doctor orders EKG to be done in the office, he reviews the results and is billing for the global EKG.

    2. Doctor orders EKG to be done in the office, he personally reviews the results and is only billing for the tracing.

    3. Doctor orders EKG to be done in office, he personally reviews the results and is not billing for the test.

    4. Doctor orders EKG to be done in office and personally reviews an old EKG.

    Can anyone answer this issue and provide supporting documentation for their answer so that I can settle this issue with my physicians?

    Thanks for all of the help I can get!
    Last edited by jdibble; 11-06-2014 at 06:34 AM.
    Jodi Dibble, CPC

  4. #4
    Location
    Coeur d'Alene, Idaho
    Posts
    134
    Default
    It has been my understanding that if the physician is ordering the services and they are being done in the office and the physician is billing for said services then no points count in the data section as it would be double dipping - the physician is receiving payment for the services that they are ordering/interpreting.

    Thanks, Amanda CPC, CCC, CEMC

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