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E/M MDM New problem "additional work up Planned"

  1. Default E/M MDM New problem "additional work up Planned"
    Medical Coding Books

    E/M MDM
    Type of Problem

    New problem, no additional work up planned
    New problem, additional work up planned

    We know that x-rays or labs are considered " additional work up" does a referral to a consultation requested by the primary care physician constitute additional work up ? CMS and our local Medicare carrier do not clarify or define " additional workup". Any information that can be provided would be greatly appreciated. Please state your references if applicable.

    Thank you,
    Sonia and Lorna CPC

  2. #2
    North Carolina
    You present a great question. This should receive many responses.

    My opinion...“additional workup planned,” describes a problem that cannot be evaluated within the confines of the encounter. "Additional workup" is needed to help find a definitive diagnosis for that encounter. This could be a diagnostic study/plan...MRI, CT, PT, etc.

    I verbally presented this question to our carrier and was informed that this type of "workup" was credited as such.

    "An example of a “new problem with no additional work-up planned” may be a new diagnosis of essential hypertension. Examples of “new problem, with additional work-up planned” may include any new clinical issue which requires further investigation such as chest pain, proteinuria, anemia, shortness of breath, etc"

    At the top of this link, there is a reference for other Medicare carriers
    Last edited by RebeccaWoodward*; 02-19-2009 at 09:39 AM.

  3. #3
    Milwaukee WI
    Default Request consult
    Yes, I would consider a decision to request a consultation as "additional work-up."

    F Tessa Bartels, CPC, CEMC

  4. Default
    Thank you everyone.

    Sonia and Lorna

  5. Default
    Thank you everyone.

    Sonia and Lorna

  6. Smile
    can face to face time be greater than counselling time in the e&m guidlines

  7. Default
    For Office and Outpatient Services, face-to-face time is counseling time. This includes the time the physician spends speaking with the patient regarding diagnostic results, surgical options, etc... If this time exceeds more than 1/2 of the visit ,then the provider may bill on time. In Inpatient Hospital, Hospital Observation, and Nursing Facility, the provider may bill on time based on unit/floor time. The same elements apply here as well, where if the unit/floor time exceeds more that 1/2 of the visit, the provider may bill on time. Unit/floor time is considered the time spent on the patients floor working on the patient's case.

    Hope this helps!

  8. Default new problem
    new problem no additional work up planned. Starting a new script for the new problem is not additional work up right?

  9. #9
    Richmond Virginia
    Quote Originally Posted by Carrie Johnston View Post
    new problem no additional work up planned. Starting a new script for the new problem is not additional work up right?
    No additional work up would be something that will have results. Like Labs for example.

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