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Preventive exam

  1. #1
    Default Preventive exam
    Medical Coding Books
    Do you agree that PE does not require MDM?

  2. #2
    Quote Originally Posted by perkins05 View Post
    Do you agree that PE does not require MDM?
    Correct - "Medical decision making" describes the physician's work in assessing the diagnosis, determining possible treatments, analyzing data, and weighing the risks of all of those factors, to determine the best course of action to address the patient's chief complaint. A 'problem' is required in order to necessitate that a 'medical decision', be made.

    Preventive exams are not designed to address problems; they are designed to prevent them. A patient may have a condition which requires some sort of MDM (say, prescription management), which could be addressed during a PE encounter, but the work involved isn't an inherent part of the PE code.

    If the physician documents the HPI, relevant ROS, exam elements, and MDM associated with the problem, you would be able to justify billing the appropriate level of problem-oriented E/M, in addition to the PE (with a 25 modifier, of course). Since the elements of ROS and exam (documented for the problem, and for the comprehensive Hx and Exam associated with the PE) overlap, the only way to assess the score of the problem-oriented E/M is by using the HPI, and MDM - those elements are unique to problem-oriented E/M's. Hope that helps!
    Last edited by btadlock1; 11-15-2011 at 04:40 AM.

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