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Help with MDM data points

  1. #1
    Location
    Overland Park, KS
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    1,166
    Default Help with MDM data points
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    This question has been asked before, but I need someone to further clarify this for me please.........

    Under the MDM part of the an audit under the Amount and/or Complexity of Data Reviewed, if the provider ordered and/or reviewed an x-ray, then one point is assigned. If there is an indepenedent visualization of image, tracing, or specimen (not simply review of report), then 2 points are assigned. Does this mean that if the provider orders an x-ray and then documents that he/she independently reviewed the film that a total of 3 points are assigned? Would this not be considered douple-dipping? I was always under the impression that in order to recieve the two points for the independent review the provider had to perform the x-ray themselves and own the equipment.

    Can someone please clarify this for me and provide me with the guidelines that explains the correct way to assign the points for this? I have a provider who is questioning an audit and thinks that she should recieve three points because she ordered the x-ray and then looked at the film. Any insight is appreciated. Thanks so very much.
    Dawson Ballard, Jr., CPC, CEMC, CPMA, CCS-P, CPC-P, CRHC, AAPC Fellow
    Coder

  2. #2
    Smile Mdm
    under MDM if physician read report and interpreted film, I would give 3 points credit...1 for read report, 2 for interpretation. I use an audit sheet that breaks all this down which is helpful when counting bullet points
    passionforcoding

  3. #3
    Location
    Overland Park, KS
    Posts
    1,166
    Default
    Thanks. Any other opinions?
    Dawson Ballard, Jr., CPC, CEMC, CPMA, CCS-P, CPC-P, CRHC, AAPC Fellow
    Coder

  4. #4
    Location
    Duluth, Minnesota
    Posts
    1,133
    Default
    Dawson,
    this is from E/M University website.
    "You can get two data points if you personally review an image, tracing or specimen. It does not matter if there is an official report already in the record (for example an official interpretation from a radiologist for a chest X-ray). All that is required is that you personally eye-ball the image, tracing or specimen AND record YOUR findings in the chart."

    http://emuniversity.com/MedicalDecision-Making.html
    http://emuniversity.com/PointsforRev...orTracing.html
    Donna, CPC, CPC-H

  5. Default
    sorry if that has already but answered but i just need clarification once again:

    Example

    Cardiologist states results of EKG in office visit note and also bills for this service.

    ...so being is an office visit with and EKG by the same provider---in the data points section is the provider getting 1 point? 2 points? or no points because they are already billing for the service and that'd be double-dipping?

  6. #6
    Location
    Duluth, Minnesota
    Posts
    1,133
    Default
    renifejn,
    The provider must document independent visualization of an image, tracing or specimen in order to count 2 points.
    If the provider separately bills for the independent visualization (e.g. prepares a written report for an X-ray), do not count this for purposes of Data Reviewed as the provider is receiving separate reimbursement for this service.
    {that's my opinion on the posted matter}
    Donna, CPC, CPC-H

  7. Default
    thanks

  8. #8
    Location
    Overland Park, KS
    Posts
    1,166
    Default
    Thanks.
    Dawson Ballard, Jr., CPC, CEMC, CPMA, CCS-P, CPC-P, CRHC, AAPC Fellow
    Coder

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