# MDM- "additional workup required" scoring



## let.forever.be (Feb 6, 2013)

I am currently auditing ED physician billing and am just stuck on scoring the Number of Diagnoses or Treatment Options in the MDM.  From my understanding, "additional workup planned" refers to testing or any other type of workup that occurs _outside_ of the encounter.  So if a patient is hospitalized for surgery or further workup after being admitted from the ED, they would qualify for a score of* 4*.  If a patient has some lab work and an x-ray done during the encounter and is diagnosed with a new problem and sent home, they would score a *3*.  I know some payers have policies regarding this, but unfortuantely we don't.

Any thoughts on this issue?  The CPMA auditing curriculum states "extensive procedures that do not have the results on the date of service can be considered as additional workup".  However, tests performed during an ED visit usually do have test results available, which helps drive the Risk scoring.  Also, points are given in the Amount and/or Complexity of Data to be Reviewed for each of these tests ordered and independently reviewed.  Would it be wrong to score for the _plan_ of this additional workup as well as the _review_ of the results in a single encounter?  

The concern is most ED providers automatically order testing in the ED regardless of the diagnosis, and a simple URI will score HIGH in the MDM category- if the Diagnosis and Complexity category are scored as Extensive, it doesn't matter if the Risk category is scored Low, since the Summary is determined by 2 out of 3.  

Found this info in another forum- http://emuniversity.websitetoolbox.com/post/ER-MDM-6111452.

I appreciate any input on this!  Thanks!


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