# MDM Additional workup planned



## jemimah crescentia (Apr 22, 2013)

Hi:

Could anyone let me know the real meaning for "additional workup planned" in the presenting problem section of Medical Decision Making(MDM), when laboratory,x-ray or any diagnostic tests had been ordered whether it could be considered as additional workup or needed a admission, referral or transfer of the patient

Thanks for your help,
Dr.Jemimah,CPC


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## Tonyj (Apr 22, 2013)

jemimah crescentia said:


> Hi:
> 
> Could anyone let me know the real meaning for "additional workup planned" in the presenting problem section of Medical Decision Making(MDM), when laboratory,x-ray or any diagnostic tests had been ordered whether it could be considered as additional workup or needed a admission, referral or transfer of the patient
> 
> ...



As per Novitas Solutions, Inc Q/A section: 18.What constitutes additional workup in the Amount and Complexity of Data grid for Medical Decision Making?

The number of possible diagnosis and/or the number of management options that must be considered is based on the number of types of problems addressed during the encounter, the complexity of establishing a diagnosis, and the management decisions that are made by the physician. For each encounter an assessment clinical impression, or diagnosis should be documented. It may be explicitly stated or implied in documented decisions regarding management plans and/or further evaluation. Additional workup is defined as anything that is being done beyond that encounter at that time. For example, if a physician sees a patient in his office and needs to send that patient on for further testing, that would be additional workup. The physician needs to obtain more information for his medical decision making.

Date Posted: 10/16/2009, Date Revised: 01/18/2013

I had recently attended a seminar for the same MAC who stated it was inclusive of any consults ordered or referrals given.


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## jemimah crescentia (Apr 23, 2013)

Thanks for your help and guidance Tony,

As per my understanding from your reply, if a patient visits the physician with sore throat or fever for which a strep test or chest x-ray had been ordered, then this could be considered as additional workup planned, Am I right?

Thanks,
Dr.Jemimah.CPC


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## shreesailam99@gmail.com (Apr 23, 2013)

yes........if patient come to  d clinic with abdomen pain and physician ordered for abdominal x-ray to rule out appendicitis..........consider x ray for additional work up..........


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## Tonyj (Apr 23, 2013)

jemimah crescentia said:


> Thanks for your help and guidance Tony,
> 
> As per my understanding from your reply, if a patient visits the physician with sore throat or fever for which a strep test or chest x-ray had been ordered, then this could be considered as additional workup planned, Am I right?
> 
> ...



Technically, yes but the question was presented at a seminar with Novitas Solutions Inc, and they stated additional workup as anything done and the results available after the pt leaves the office per se. So, if the pt had a chest x-ray, blood work, fast strep in the office where results are established prior to the pt leaving the office it wouldn't be additional work-up! Doesn't sound fair to ED physicians does it? I'm in total disagreement and I can't find it in writing on their website.


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## MnTwins29 (Apr 24, 2013)

Maybe this falls under "thinking too much" - but could it be that these would not be counted under additional work up because they would be worth 2 data points each and therefore have already contributed toward the MDM?    These would be in the MD's "home court" if you will and therefore the MD and his/her staff are the ones performing these tests not someone else, hence they get the credit for the data points.   

Interesting that a speaker at a Webinar mentions it, but it cannot be verified.  Maybe you should inquire in writing?


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## jemimah crescentia (Apr 24, 2013)

Thanks a lot to all who had shared their knowledge and answers over here.....


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