Wiki Data point in MDM

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Hi

If the provider’s note has the name of the labs reviewed, their results and the date the lab was performed, is this sufficient to give provider credit that these labs were reviewed?

Or should provider explicitly state labs reviewed and assess individual lab results?

Thanks
 
If provider ordered a test/lab and reviewed/interpreted the results during the E/M visit, and the interpretation is of it's own CPT descriptor, you can only count 1 data point for the order of the test.

If a different provider ordered the test/lab, and your provider interpreted the results during the E/M visit, that’s 1 data point.

If a different provider ordered a test/lab, and your provider reviewed the already interpreted results, this is considered review of the medical record which should have already been counted as 1 data point for the entirety of the medical record.

Hope that helps!
 
Last edited:
RaveenaS said:
If provider ordered a test/lab and reviewed/interpreted the results during the E/M visit, that’s 2 data points

If a different provider ordered the test/lab, and your provider interpreted the results during the E/M visit, that’s 1 data point.

If a different provider ordered a test/lab, and your provider reviewed the already interpreted results, this is considered review of the medical record which should have already been counted as 1 data point for the entirety of the medical record.

Hope that helps!
Click to expand...
this is not correct. provider cannot count both the order AND the review of the same test.

per NGS:
  1. Please define the circumstances in which a provider may take MDM credit for ordering and reviewing diagnostic tests.
Answer: When a provider orders a diagnostic test that will be performed, interpreted, and billed:

      • By a different provider, the ordering provider may take credit for ordering the test or reviewing the results during the visit (e.g., chest X-ray, CPT 71046).
      • By his/her office or group, then no credit may be allowed for the order or review in the MDM component of the visit. This is because reimbursement for the interpretation of the test is included in the fee for the diagnostic service (e.g., EKG, CPT 93000).
      • By his/her office or group, but does not require or include separate interpretation, the ordering provider may take credit for ordering and reviewing the test during the visit (e.g., CBC, CPT 85025).
      • ________________________________________________________
per AMA (emphasis added by me):

Are tests counted for the data component of MDM when they are ordered or resulted? The data component of MDM includes the thought processes for diagnosis, evaluation, or treatment. Any ordered test is presumed to be analyzed when it results; therefore, the test is counted in the encounter when it was ordered. Tests ordered outside of an office visit (eg, with pre-visit labs) may be counted in the encounter in which they are analyzed. In the case of a recurring order, each new result may be counted in the encounter when it is analyzed.
_________________________________________________________
 
Hi

Getting confusion about the data point for calculate the level. If provider ordered 4 labs with two chronic condition then what level of EM we will append. and how to calculate that ?

In 4 lab order how to find the bullet points which mentioned in MDM table. Please explain about this also lot of confusion in this point also
 
sanmitasb said:
Hi

Getting confusion about the data point for calculate the level. If provider ordered 4 labs with two chronic condition then what level of EM we will append. and how to calculate that ?

In 4 lab order how to find the bullet points which mentioned in MDM table. Please explain about this also lot of confusion in this point also
Click to expand...
If you have the current book, page 8 is the table. Are the two chronic conditions stable (that’s low) or not (moves to moderate) is the first question. Are each of the tests he/she ordered unique? Example: a PVR is going to be separate from a urine culture, that would be ordering 2 different tests. If he’s reviewing the results in the same visit, the CPT is inclusive of that review and review won’t be counted to data points.
 

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RaveenaS said:
If you have the current book, page 8 is the table. Are the two chronic conditions stable (that’s low) or not (moves to moderate) is the first question. Are each of the tests he/she ordered unique? Example: a PVR is going to be separate from a urine culture, that would be ordering 2 different tests. If he’s reviewing the results in the same visit, the CPT is inclusive of that review and review won’t be counted to data points.
Click to expand...
From my understanding- 1 Chronic stable illness/condition = Presenting problem is Low level
2 or more Chronic stable illness/conditions = Presenting problem is Moderate level
 
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