# Medical Decision Making - visualization of image



## ahinman (May 12, 2010)

This may sound like a crazy question.....but a consulting firm just took a look at some of our ERs and an area they are telling us that in the Amount and/or Complexity of Data....They are counting 1 point for ordering an X-ray then they are counting 2 points for independent visualization of image.  

Can anybody give me insight into what you are doing at your facility.  Also, if you are doing it the same way as the consultants do you have any documentation from an FI that is telling you it is okay to do it this way?

Thank you!!


----------



## KatHopkins (May 12, 2010)

I just checked three different E&M audit worksheets...all of them have "independent interpretation of image, tracing, specimen" or some variation thereof listed under MDM, extent of data analysis, as 2 points.   (The other 2 point item is review of old records or additional history from source other than patient.)

In the ER I code for, the doctors must add a written note (or dictation) that they did their own interpretation, or check off the box on the T-sheet that states they did so.   This happens frequently with Imaging - the ER docs will interpret the image themselves, and the radiologists review it later...the patient may be called if something is found by the radiologist that the ER doc did not spot.  

Hope that helps...


----------



## ahinman (May 12, 2010)

Thanks for your reply Kat.....

My physicians are stating that they did their own interpretation and they do document what that opinion is... and I am giving them the 2 points for Independent visualization of image, tracing or specimen.....

What the consulting firm is saying is count 1 point for ordering the test and then 2 more points for the interpretation.....

Thoughts??


----------



## AuntJoyce (May 12, 2010)

*Medical Decision Making*

Your question about points was an issue that we recently discussed at great length:

As an example, take a patient that is seen by a hospitalist upon admission and the physician states:

Blood work is reviewed, etc. - you assign 1 point for this

Report of x-rays taken in the E.R. show consolidation in the lungs.  These films were personally review by me - you assign 1 point for reviewing the report and you assign an additional 2 points for the personal review of the films

EKG done in the E.R. reported to show abnormal sinus rhythm.  I personally reviewed the electrocardiogram - you assign 1 point for review of the report but because you already assigned 2 points for the personal review of the x-rays, you cannot claim them again

You can, at most, have 5 total points in this section (review of data).

Hope this helps,

Joyce


----------



## ashack63 (May 13, 2010)

According to the CMS audit tool, you would assign 1 point for the ordering of the xray also.

In the above example, ordering and reviewing labs = 1 point
Interp films ordered by another provider = 2 point
EKG interp would not give add'l points as you can only have the 2 points for interp one time.
However, if the current provider orders another EKG - you would get the 1 point for that
total of 4 points
If the current provider orders a CT, or additional xrys, you would get another point
70000's ordered- 1 point
80000's ordered- 1 point
90000's ordered- 1 point
interp or independent visualization of any or all of the above = 2 points
hope this helps
Anne


----------



## KatHopkins (May 14, 2010)

Sorry I mis-understood your concern.   When I first started coding for the ER, I also thought of it as an either/or kind of thing (1 point for ordering *or* 2 points for order and interpret) - it took an auditor to explain it to me, too!


----------



## ahinman (May 17, 2010)

Thank you all for posting.  I was able to speak with our Medicare representative on Thursday.  And she stated it is either 1 point for ordering the x-ray OR 2 points or the interpretation.  Not both.

Thanks again!!!


----------



## ashack63 (May 18, 2010)

*Cms education*

http://www.cms.gov/MLNProducts/downloads/eval_mgmt_serv_guide.pdf
I hope this helps you, it breaks down the amount and complexity of data to be reviewed.
I have tried to attach a CMS audit tool, but the file is too large.
Anyway, when we call our local (First Coast), we always ask the same question to three different people, you'd be suprised at the different answers we receive.
The last Medfest I went to also addressed this question, and the answer was credit for ordering and credit for independent visualization.
Anne


----------

