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Thread: Help with MDM data points

  1. #1

    Default Help with MDM data points

    AAPC: Back to School
    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
    Compliance Auditor

  2. #2
    Join Date
    Apr 2007

    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

  3. #3


    Thanks. Any other opinions?
    Dawson Ballard, Jr., CPC, CEMC, CPMA, CCS-P, CPC-P
    Compliance Auditor

  4. #4
    Join Date
    Apr 2007
    Duluth, Minnesota


    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."

    Donna, CPC, CPC-H

  5. #5


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


    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
    Join Date
    Apr 2007
    Duluth, Minnesota


    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. #7



  8. #8


    Dawson Ballard, Jr., CPC, CEMC, CPMA, CCS-P, CPC-P
    Compliance Auditor

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