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Thread: general question....

  1. #1

    Question general question....

    AAPC: Back to School
    any one have thoughts on this???
    recently heard but don't know if true....can you increase the level of an e/m visit if there was a decision for a major surgery, rx mangmt, or 3 data pts??

    I've never seen this mentioned in medicare guidelines or other carrier guidelines.


  2. #2
    Join Date
    Apr 2007


    Those are all elements of medical decision making. Can you up a level just based on one of those, not really. MDM is 2 of 3 so if you have 3 data points and rx management you could get moderate MDM even if you dx points are at 2. But you still have to meet the level with the other key components required for the code set you are in.

    For new/consults they are 3 of 3, so you could have Detailed history, Problem Focused exam, and Moderate MDM, you are still stuck at a level 1 regardless of your level of MDM.

    On established codes it is 2 of 3 so it is possible that those things you mentioned could help up your level, depending on what the other key components end up being.

    Laura, CPC

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