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MDM - Independent Visualization

  1. #1
    Default MDM - Independent Visualization
    Medical Coding Books
    Can I please get some opinions out there in coding land? I was always under the impression that if a physician billed for the professional component of an X-ray or CT scan, that he would not also get the 2 points for the independent visualization of an image under the Complexity of Data in the MDM. Is this correct or not and if not does anyone know where I can find an official documentation of that??? Thank you very much for any help on this!!!!

  2. #2
    North Carolina
    I have been trained the very same way. If the physician bills for the global component of a radiology exam, the physician does not receive credit for independent visualization since he's already receiving reimbursement for the professional component. However, the physician should receive credit for ordering. As for official documenation, I don't know that you'll find it in "black & white", unless your carrier issues a statement on this. I wrote to our local Medicare medical director and his response did, somewhat, support the above. He did leave a margin of flexibility for those cases that were out of the norm in the event an appeal needed to take place based on medical necessity. There wasn't any eleboration on what that "out of norm" situation would be.

    I have also attended a few E/M auditing workshops conducted by the AAPC and this was also their interpretation. The last workshop I attended was 10-2009 and this was a heavily discussed topic. I find that this area is a topic of debate from coder to coder and I recommend contacting your carrier for their guidance.

  3. #3
    Milwaukee WI
    Default Wisc. State Medical Society
    The E/M Coding Symposium put on by the Wisconsin State Medical Society in October 2009 addressed this issue exactly as Rebecca outlines.

    If you are getting paid to interpret the X-ray you cannot also use that same exact service as part of your E/M. But ordering the X-ray does still count toward data points.

    F Tessa Bartels, CPC, CEMC

  4. #4
    Thanks for the info Rebecca and Tessa, that's what I thought..

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