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Thread: Medical Decision Making

  1. #1

    Default Medical Decision Making

    AAPC: Back to School
    Are there any simple rules to follow to determine the level of MDM? For example I was told, by an auditor, that you would only need one DX and one procedure or one DX and one prescription to qualify for a moderate level.

  2. #2
    Join Date
    Apr 2007
    Milwaukee WI

    Default Three components to MDM

    The best thing to do is to google 1997 or 1995 E/M guidelines and audit tool. That will give you the worksheet for determining your MDM.

    There are three components to MDM:
    Problem points
    Data Points

    To arrive at the level of MDM you add your problem points
    0-1 = minimal
    2 = limited
    3 = multiple
    4 or more = extensive

    Then add your data points:
    (same scale as for problem points)

    Then look at your Table of Risk

    To get your overall level of MDM 2 of these areas must meet or exceed:
    So if you have 3 problem points, 0 data points and moderate risk you have Moderate MDM.

    So the auditor was correct ... in a VERY simplified fashion. If you have a NEW problem without any workup (e.g. patient presents with sinus infection) and you are prescribing medication (Rx for antibiotics given), you have 3 problem points and moderate risk which equals moderate MDM.

    But what if your "new" problem is just a cold ... which would get better by itself without any intervention. Even if your physician writes a prescription for cough medicine (because Mom insists) you still only have 1 problem point and you will have straightforward MDM.

    Hope that helps.

    F Tessa Bartels, CPC, CEMC

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