Wiki Data Points of MDM table, PLEASE HELP:)

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We are having a discussion and a difference of opinion on the data points. It mostly has to do with EKG's, some coders give a total of 3 points to the provider if they order and document reading results as required. So the ordering of the EKG and then the provider personal reviews this and gets 2 more points. This seems like double dipping to me, but I could be wrong. I would just give the 2 points for the reviewing of imaging. Any thoughts and resources. I have already looked at a few medicare sites, but none of them specifically give an answer to this questions?
Thank you in advance to everyone who responds?:confused::eek:
 
This is interesting. I have never thought about it but I always just give them 2 pts if they are ordering and reading their own EKGs.

My take on would be that if you are reading a test and it counts toward data pts on E/M you are obviously the one who ordered it, otherwise it would be a non issue and you would only charge for reading the EKG. So it wouldn't make sense to give additional credit for ordering the testing to be done.

I agree with you that is sounds like double dipping. Hopefully someone will have a resource to clarify this.

Laura, CPC
 
An independent visualization of an image, tracing or specimen is diagnostic in nature and if you personally are making judgements and decisions that will impact the plan of care for the patient, you get credit for this in addition to the credit you get from ordering the test because these are two separate activities. Both involve decision making -- something prompted the physician to order the test. Seperately, he is personally making decisions from that test .... he gets credit for both whether on different days or the same day.

If a patient came in on 5/1/09 and say an x-ray was ordered- the credit should go towards that E/M for that day. (1 point)

If they come back on 5/2/09, the same physician who ordered the x-ray, personally visualized and made decisions based on his findings. He gets credit for that too, right? yes, towards the E/M for that day. (2 points)

So, having a medicine test, EKG in your case, ordered and independently reviewed on the same day, doesn't matter. He is awarded 3 credits for it-- either on the same day towards a single E/M encounter .... or 1 point at the first encounter and 2 points at the second encounter.

Hope that helps!
 
http://emuniversity.com/MedicalDecision-Making.html


Data Points

The physician should be aware that no “double dipping” is allowed. For example, if you review lab results and order labs during the same visit, you only get one point (not one point for ordering and one point for reviewing). This same rules applies to imaging studies or other medicine tests such as EKGs or PFTs. Commonly overlooked points are those garnered for obtaining or reviewing old records. If you do review old records, you must summarize your findings in the chart. It is not acceptable to just say, “Old records were reviewed.”

I don't always agree with Dr. Jensen but thought this was interesting.

Laura, CPC
 
I agree on it for labs. normally the ordering physician isn't determining the final dx as a pathologist does.

I don't agree with him on some things either. I was just reading a case archive where he posted modifier 25 could only be billed if e/m and procedure was done on same day. The example was an admit and critical care on same day and he said you couldn't use modifier 25 ... which yes you are suppose to
 
I think some clarifications needs to be given. When is the physician ordering the test? Is the test being performed in physician's office the same day? Or did physician review test on a second day?

Say test ordered day 1 only, 1 pt for ordering consider in that E/M.

If pt had test performed at outside location and brought it to office say day 2, 1 pt for physician review in that E/M.

If ordered and reviewed on same day, one E/M, 1 pt total. My understanding has always been reviewed overrideds ordered.

I used the Marshfield Clinic Tool. It has 1 pt each for ordered/reviewed Medicine section test (I paraphrased here).
 
Below is what I was given from the corporate coders. So I will change what I was doing.

Thanks for this thread ladies!!!!


From Highmark Medicare Standards, 2 pt (independent visualization of image) would be given...for the interp. However, the notes must state that the provider personally interp the image (not simple reading the report of the radiologist.

Other carriers have not set this kind of standard...I would recommend being a little more on the reserved side and give 2 pts (independent visualization of image) vs the 3pt. (order and independent visualization of image).

Here is a cut and paste from Medicare Q&A on E/M
http://www.highmarkmedicareservices.com/faq/partb/pet/lpet-evaluation_management_services.html#4

If I personally review a film, e.g. x-ray, EKG in my office, will I receive additional credit on the E/M score sheet?
Yes, two points may be given for independent visualization of an image, tracing or specimen on the E/M score sheet in the Amount and/or Complexity of Data Reviewed section under the Medical Decision Making key component. The medical record documentation must clearly indicate that the physician/qualified NPP personally (independently) visualized and performed the interpretation of the image, tracing or specimen and that he/she did not simply read/review a report from another physician/qualified NPP. For additional information on E/M services, please refer to Medicare A/B Reference Manual, Chapter 23 and/or the E/M score sheets.
 
To clarify, the physician is not necessarily the one who orders the EKG, but I think they are giving him the 3 points for review and/or order tests i the medicine section of the CPT and 2pt for independent review of image, tracing or specimen.
I loved all the comments and resources, they are all so helpful and BIG thank you to everyone.
 
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I am signing in a bit late today, but would like to add my comment to your great post.
I would give either one or two points depending on what is documented. If the provider states that s/he personally reviewed the tracing I would allow 2 points. If the documentation does not specify such or state that the report was reviewed, then only 1 point can be given. On occasion the provider may look at the tracing and decide that another EKG is required - in that case I would also give a point for ordering the additional test. This also goes for labs, radiology, PFTs etc. The documentation must be very clear in order to get additional points. I would not give 3 points because s/he looked at the image/tracing/specimen and then looked at the report as well.
 
Re-opening this question

I am having an issue with my providers with this same issue about how to score the Data points and some information that they received from an outside "consultant".

I am coding for cardiologists who do EKG's in the office. Originally they were billing the global 93000 for these, however after an audit it was apparent they were not documenting a separate interpretation for the EKG, so until this can be cleared up, they are only billing for the tracing. First, I was under the impression that if the physician is billing separately for the test, then they would not get any points under Data as they are receiving the reimbursement for the test. However the consultant states otherwise. Then, the consultant is stating that if the physician orders the EKG and also independently visualizes the test, they would get 3 points - 1 for ordering, 2 for the visualization. I believe I was told by Novitas during one of their E/M webinars that if they did the visualization then you would only assign the 2 points and also that if they were billing for the test, the would get no points for ordering or visualization.

Can anyone answer this issue and provide supporting documentation for their answer so that I can settle this issue with my providers?

Thanks for all of the help I can get!

Jodi
 
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