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Data Points for Medical Decision Making

  1. Default Data Points for Medical Decision Making
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    We have been to several seminars lately that provided conflicting information on how to assign points in the amount and/or complexity of data to be reviewed section of medical decision making. One presenter stated you are allowed to give one point for review of every separate type of test done per date of service. Another presenter said you are allowed only one point per test type regardless of the number of tests that were done or what dates they were performed. For example, at an office visit on 4/19, the MD reviews the reports of a CBC done 4/19, a comprehensive metabolic panel done 4/18, a MRI head done 4/15, a CT chest/abdomen done 4/16, and pathology report from a colonscopy done 4/14. The first presenter would argue that there are 5 distinct tests done for a total of 5 points. The second presenter would argue that there is 1 lab point, 1 radiology point and 1 other point for a total of 3 points. Does anyone have any documentation to support either viewpoint?

  2. #2
    In the amount of complexity it says "lab(s) so that would be all labs would be 1 point. The same goes for x-ray, all x-rays would be another 1 point. The date does not matter as long as the doctor has not use them before for points. If it the first time going over them with this patient then yes they count.

    Hope this helps,

    "Life isn't about waiting for the storm to pass...It's about learning to dance in the rain."

  3. #3
    Columbia, MO
    this is the subjective part of the guidelines. No where in the 95 or 97 guidelines does it say to use points to make a determination. Or even what would constitute a point. You just need to be consistent. Different Instructors will teach it in a manner that is consistent for them but in this case you need to make your own interpretation of the guideline.

    Debra A. Mitchell, MSPH, CPC-H

  4. #4
    Default question for question???
    Well that is good question. I always thought that 1 point per test. However, this poses another question that I have not been counting at all. You mentioned colonoscopy reveiwed. What category does that fall in. If that physician documents that the patient had a colonoscopy 6 months prior, and speaks of the results, then would that construded as review of old records, or can you not count that because it does not fall into the category of lab, radiology or medicine section.
    Kristen Richard, CPC

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