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Thread: Mdm

  1. #1

    Default Mdm

    AAPC: Back to School
    One of the areas I have the hardest time auditing is the MDM. Is there a list somewhere with what is considered self-limited or minor problems. Also, what is considered a new problem. Is a "cold" considered a "new problem" or minor problem. In my mind, I'm thinking if the doctor hasn't seen you for the problem, it's a "new problem", but I don't think it works that way. Any help will be appreciated.

  2. #2


    You can go to the CMS website www.cms.gov and download the 1995 and/or 1997 guidelines, depending on which guidelines you are using to do your audits. The guidelines tell you what you can and can't count for each given level. MDM involves risk, amount of data to be reviewed, number of diagnosis and management options so it is a little more involved. I always use 97 guidelines because it gives you more of an objective tool to conduct your audits.

  3. #3
    Join Date
    Apr 2007
    Northwest Ohio


    I always look at has the provider seen this problem for the patient before... If the patient is coming in for new symptoms that they are experiencing it is a new problem, but just because it is a new problem does not increase the amount of MDM....
    1) Patient presents for cold symptoms....diagnosed with a cold: new prob no additional work up (3) the doc instructs to use mucinex and robitussin (low risk) = low MDM
    But then it could go like this:
    2) Patient presents for cold symptoms.....diagnosed with acute bronchitis....new problem no additional work up (3) doc gives rx for zpack and diabetic tussin d/t patients DM (moderate risk) = moderate MDM

    All depends on all factors of the MDM because like this time of year the offices are getting a lot of the same type complaints because of bugs going around......

    Does that help?
    Mandy Flagg, CPC, CEMC
    Compliance Auditor

  4. #4


    yes, that does help

  5. #5
    Join Date
    Apr 2007
    Milwaukee WI

    Default Self-limited or minor problem

    Even if it is a "NEW" problem, if it is a cold (and diagnosed as such) it is self-limited.

    I.e. even if you do NOTHING, the problem will resolve on it's own

    (Although, I have actually discovered a cure for the for the common cold -- chocolate ice cream - one scoop per day for 7-10 days and your cold will be cured!)

    Hope that helps.

    F Tessa Bartels, CPC, CEMC

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