Wiki E/M Data Element

[gbgentry@earthlink.net]

Is it correct that if a patient has, for example, three Lab tests or a Lab, X-Ray, and CT, then they're considered to have 3 Elements - Moderate because of the three "unique tests"? Or does that only count as 1 and they still need two more from either Review of prior external notes, Review of results, or Assessment requiring an Independent historian? Thanks.

 

[lgardner]

if the provider is ordering 3 labs (or other orders), they would each count.
HOWEVER, they would not count if they are being billed by the provider.
AND, if they were not being billed by the provider, you can only count the ordering OR the review of the tests.

there is some great information here:
Noridian ACT Q&A for E/M

 

[keke74]

In the CPT book at the top of Table 1, it states *each unique test, order, or document contributes to the combination of 2 or 3 in Category 1. However, in my opinion, it's still open to interpretation. My interpretation as it relates to meeting the requirement for category 1 is if for example as you stated a lab, x-ray and CT was ordered, I would only count it as one element & 2 more of those bullet points would still be needed to fulfill the requirement of category 1. As a matter of fact, that's what I have been doing. Again, I think this is open to interpretation especially when there is a separate bullet point for ordering & reviewing each unique test. I have reviewed presentations, articles, etc. and I think this is another one of those gray areas based on the various interpretations of others.

 

[keke74]

This is an update to what I found in regard to Category 1.
Per ACEP, it reads as follows:

A combination of different Category 1 elements are summed to determine the total.

A lab test ordered, plus an external note reviewed and an independent historian would be a total of three for Category 1 under moderate or extensive data.

All the Category 1 value can come from a single bulleted element.

Ordering an EKG (93010), a CBC (85027), and a CMP (80053) is a total of three for Category 1, even though they are all from the same element (Ordering of each unique test).

Ordering a CBC, CMP, and cardiac troponin is a total of three for Category 1, even though they are all lab tests, as each test has a unique CPT code

I think the above information provides a better explanation in regard to Category 1 and it provides a better understanding of this category for me as well. Hope this helps!

 

[acuyou]

It seems clear the way the new MDM grid is laid out. The center column that captures the DATA is a check off system. Increasing the amount of DATA captured is set for each level by meeting the category bullet(s) or the complete single check-off category DATA requirement (test interpretation and/or discussion of management). The "amount" of Testing, Management, and/or discussion of treatment, etc., increases and supports your risk level and overall level of service, not even yet considering the complexity of the problem(s) addressed for that level of service or the actual classification of that presenting problem(s).