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Thread: Calculating Data Complexity of E/M code

  1. #1

    Cool Calculating Data Complexity of E/M code

    AAPC: Back to School
    I am planning to take the E/M auditor speciality and I need to know where I can find information on calculating data complexity. My biggest question is concerning counting points for lab services. If a patient is given 3 or 4 diagnosis and labs are attached to each does it still only count for 1 point?

    Example Pt has DM and an A1C is ordered, HTN and a HDL/LDL is ordered , the patient also has unspecified anemia and a Fe panel is ordered. Do I still assign only 1 point? My concern is that because if the patient has 2 or more stable chronic illnesses this has the possibility of raising the level of E/M services. Of the various resource materials I have researched I never get a clear cut answer that you can only count labs as 1 point or it counts as 1 point per diganosis examined and treated. Thanks in advance.
    Last edited by VDENISE; 03-31-2009 at 10:39 AM.

  2. #2


    No matter how many labs are ordered/reviewed, for whatever reason/diagnosis, the provider gets credit for 1 point.

    If the patient has multiple issues, this is where the "problem points"
    and "risk" comes into play.

    So let's just say.......

    You have 2 established problems, stable/improving... DM and HTN - you get a total of "2 problem points".

    For "data points" (labs) you get 1 point regardless of the number of tests.

    Then, for risk - I would use "moderate" 2+ stable chronic illnesses

    So then overall, your level of Medical Decision Making would be LOW

    Does that make sense?

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