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Medical Decision Making - visualization of image

  1. #1
    Johnstown, Pennsylvania Chapter
    Default Medical Decision Making - visualization of image
    Exam Training Packages
    This may sound like a crazy question.....but a consulting firm just took a look at some of our ERs and an area they are telling us that in the Amount and/or Complexity of Data....They are counting 1 point for ordering an X-ray then they are counting 2 points for independent visualization of image.

    Can anybody give me insight into what you are doing at your facility. Also, if you are doing it the same way as the consultants do you have any documentation from an FI that is telling you it is okay to do it this way?

    Thank you!!

  2. #2
    I just checked three different E&M audit worksheets...all of them have "independent interpretation of image, tracing, specimen" or some variation thereof listed under MDM, extent of data analysis, as 2 points. (The other 2 point item is review of old records or additional history from source other than patient.)

    In the ER I code for, the doctors must add a written note (or dictation) that they did their own interpretation, or check off the box on the T-sheet that states they did so. This happens frequently with Imaging - the ER docs will interpret the image themselves, and the radiologists review it later...the patient may be called if something is found by the radiologist that the ER doc did not spot.

    Hope that helps...

  3. #3
    Johnstown, Pennsylvania Chapter
    Thanks for your reply Kat.....

    My physicians are stating that they did their own interpretation and they do document what that opinion is... and I am giving them the 2 points for Independent visualization of image, tracing or specimen.....

    What the consulting firm is saying is count 1 point for ordering the test and then 2 more points for the interpretation.....


  4. Default Medical Decision Making
    Your question about points was an issue that we recently discussed at great length:

    As an example, take a patient that is seen by a hospitalist upon admission and the physician states:

    Blood work is reviewed, etc. - you assign 1 point for this

    Report of x-rays taken in the E.R. show consolidation in the lungs. These films were personally review by me - you assign 1 point for reviewing the report and you assign an additional 2 points for the personal review of the films

    EKG done in the E.R. reported to show abnormal sinus rhythm. I personally reviewed the electrocardiogram - you assign 1 point for review of the report but because you already assigned 2 points for the personal review of the x-rays, you cannot claim them again

    You can, at most, have 5 total points in this section (review of data).

    Hope this helps,


  5. #5
    According to the CMS audit tool, you would assign 1 point for the ordering of the xray also.

    In the above example, ordering and reviewing labs = 1 point
    Interp films ordered by another provider = 2 point
    EKG interp would not give add'l points as you can only have the 2 points for interp one time.
    However, if the current provider orders another EKG - you would get the 1 point for that
    total of 4 points
    If the current provider orders a CT, or additional xrys, you would get another point
    70000's ordered- 1 point
    80000's ordered- 1 point
    90000's ordered- 1 point
    interp or independent visualization of any or all of the above = 2 points
    hope this helps

  6. #6
    Sorry I mis-understood your concern. When I first started coding for the ER, I also thought of it as an either/or kind of thing (1 point for ordering or 2 points for order and interpret) - it took an auditor to explain it to me, too!

  7. #7
    Johnstown, Pennsylvania Chapter
    Thank you all for posting. I was able to speak with our Medicare representative on Thursday. And she stated it is either 1 point for ordering the x-ray OR 2 points or the interpretation. Not both.

    Thanks again!!!

  8. #8
    Default Cms education
    I hope this helps you, it breaks down the amount and complexity of data to be reviewed.
    I have tried to attach a CMS audit tool, but the file is too large.
    Anyway, when we call our local (First Coast), we always ask the same question to three different people, you'd be suprised at the different answers we receive.
    The last Medfest I went to also addressed this question, and the answer was credit for ordering and credit for independent visualization.

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