# E/M Medical Decision Making



## LPou1003 (Mar 4, 2015)

Hi everyone, 

I do a lot of encounter reviews and I was wondering if anyone could give me their opinion in giving credit to a provider when they state under the plan of a Dx, "continue medication."

Would you give the provider credit for management of prescription drugs (moderate), even though they did not make any changes to the current medication, or not? No new meds were added either.

Thanks for your help,

Leslie CPC, CEMC


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## vanessa415 (Mar 4, 2015)

Hi-

Yes, I would consider that as medication management (moderate on table of risk).

Vanessa CPC, CEMC


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## coder1956 (Mar 4, 2015)

Leslie,

I tend to look at the nature of the presenting problem column when I do reviews. Many visits could be coded as a 99214 when the issue is an acute uncomplicated issue. 

An example is otitis media. A new complaint would score a 3 on Table A and prescription drug management would give a moderate complexity decision-making which would be reported as a 99214 for an established patient. 

Doesn't seem right to give the same level of decision-making to otitis media as for a follow-up of 3 stable chronic conditions on meds.

Your thoughts?

Susan


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## Christineaj82 (Mar 26, 2015)

An example is otitis media. A new complaint would score a 3 on Table A and prescription drug management would give a moderate complexity decision-making which would be reported as a 99214 for an established patient. 


On this example how do you come the leve of new problem when otitis media is a self-limited minor problem?


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## kgrantham@wkhs.com (Mar 27, 2015)

Christineaj82 said:


> An example is otitis media. A new complaint would score a 3 on Table A and prescription drug management would give a moderate complexity decision-making which would be reported as a 99214 for an established patient.
> 
> 
> On this example how do you come the leve of new problem when otitis media is a self-limited minor problem?



So you're essentially saying  that a provider who manages that a screaming inconsolable 8 month old, rules out meningitis via physical exam and identifies a bulging purulent eardrum and prescribes an oral or intramuscular antibiotic should bill their service as a 99212; the same level as an insect bite for which the provider recommends OTC hydrocortisone.


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## lace659 (Mar 30, 2015)

Why wouldn't you? 3 stable chronic conditions would give you 3 pts on Table A (1pt each condition), and prescription drug management of any those conditions is Moderate Risk, combined with a detailed exam (5-7) is 99214. 

Same with Otitis Media - 3 pts for new problem on Table A, moderate for risk for prescription antibiotics, along with a detailed exam (5-7) would also give you a 99214.


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## mitchellde (Mar 30, 2015)

MDM is composed of three characteristics, prescription drug management is only indicative or moderate risk, which does not automatically translate into moderate MDM.  For a single dx such as otitis media which is a limited minor diagnosis, and if no testing is ordered or reviewed you have no complexity of information, you easily could have straight forward decision making and with an established patient the history is usually focused or expanded focused at best which gives you a 99212 or 99213.  Last year CMS stated that medical necessity (diagnosis) is what determines the visit level.  So for a diagnosis such as otitis media or insect bite it is logical for a level 2 or 3.


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## lace659 (Mar 30, 2015)

If otitis media is a new problem with no follow up, it is 3 points in table A. In the Table of Risk, remember the highest level of risk in any one category (presenting problem, diagnostic procedure or management options) determines the overall level of risk.  If a prescription antibiotic is prescribed to treat the otitis media that falls under moderate level of risk (Prescription drug management). Medical Decision Making is a total of 2 out of three from Table A, Table B and Risk. 3 points for table A and moderate for prescription drug management is a Moderate Medical Decision Making.

Laura D., CPC, CEDC, CEMC


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## mitchellde (Mar 30, 2015)

Ok from the table for MDM the first column is number of diagnosis/management options
Minimal, limited, multiple, extensive... The second column is complexity of information, minimal, limited, moderate, extensive, and the third is risk straightforward, low, moderate or high.  A single self Limiting diagnosis is minimal, with not tests ordered or reviewed the complexity is minimal, and with prescription drug management risk is moderate making the MDM straightforward.  Even if you say the single diagnosis needed a more indepth review due to a rule out meningitis and say it is limited the MDM gets no better than low complexity.  You cannot assign moderate MDM just due to prescription drug management.


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