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

  1. #1

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

    AAPC: Back to School

    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
    Join Date
    Apr 2007
    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
    Join Date
    Apr 2007
    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. #4


    Thank you everyone.

    Sonia and Lorna

  5. #5


    Thank you everyone.

    Sonia and Lorna

  6. #6


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

  7. #7


    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. #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
    Join Date
    Apr 2007
    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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