General Surgery Coding Alert

Question: To comply with the CMS rule about appropriate use for imaging, we recently added a Clinical Decision Support Mechanism (CDSM) module to our Electronic Health Records (EHR). Does a physician have to query the CDSM, or can support-staff run this and inform the physician?

Louisiana Subscriber

Answer: Whoever is ordering the test is the clinician who needs to get on the software, advises Cindy C. Parman, CPC, CPC-H, RCC, AHIMA Approved ICD-10-CM trainer and executive vice president of Coding Strategies, Inc. It is a decision tree and there are questions about the patient that must be answered.

And what if your surgeon doesn't agree with the CDMS' recommendation? You can override it, but think twice. CMS will identify individuals that consistently override the CDSM and they will be put on pre-authorization for those tests. This program is intended to save CMS $200 million over the next 10 years.

Details: The CDSM software may link into your EHR, but with some systems it will be an entirely separate program. Starting July 1, 2018, providers may use modifier QQ (Ordering professional consulted a qualified clinical decision support mechanism for this service and the related data was provided to the furnishing professional) to show that they consulted Appropriate Use Criteria for advanced diagnostic imaging for Medicare patients (like CT, PET, or nuclear medicine).