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  • Determining the level of Medical Decision Making.

  • The new E&M video is fantastic for determining the level of MDM. Itís described very well

  • so I just want to give a shout out for that.

  • Laureen: Yeah, thatís the CEU Webinar that sheís talking about thatís pending getting

  • CEU approval. But in the Blitz videos, I do cover E&M coding but because itís 2 days

  • where Iím doing this review Blitz and E&M codes are only 10 of the 150 questions on

  • the exam, I canít spend as much time as I would like to teaching it. So on the CEU one,

  • itís 3 hours. Itís more expanded and Alicia wrote the CEU quiz for me. So she had her

  • students watch it and I guess it was helpful so thatís good.

  • Alright, so where Iím going is in your CPT manuals, there is a Medical Decision Making

  • table in your E&M guidelines. And it happens to be on page 10. And of course, this is just

  • 1/3 of the E&M you know, when youíre coding by the history exam and Medical Decision Making.

  • And as you can see, I like to mark things up and make it more visual. I actually drew

  • a line and made them look like columns because thatís what they are. To the far right is

  • the score, if you will, or the level of Medical Decision Making.

  • So youíve got straight-forward, low, moderate, and high. The first column is what I call

  • DMO for number of diagnoses or management options. And then choices you have are minimal,

  • limited, multiple, extensive. And Medical Decision Making is one of the most nebulous

  • areas of E&M to try and score. And youíve probably seen E&M scoresheets that they and

  • help quantify these things. But for purposes of the board exam, youíre not bringing in

  • an audit tool so you are going to have to use this language ñ minimal, limited, multiple,

  • extensive. Like for me, okay, Iím like, ìminimal versus limitedî. They sound pretty similar

  • to me so what youíll typically find is they count 1, 2, 3, 4. Itís for one diagnosis

  • for management option, limited is for two, etcetera.

  • For the second column, data, itís amount and or complexity of data to be reviewed.

  • So the types are minimal or none, limited, moderate, extensive. So those are the choices

  • there. When theyíre talking about data, it could be them reviewing an x-ray or reviewing

  • reports from a test that was run or lab results. Anything like that is reviewing of data. Again,

  • on those score sheets for Medical Decision Making, theyíve got this whole little point

  • system on how they add it up. You know, was the test in the radiology section? Was it

  • test from the lab section? And they kind of come up with a scoring system to figure out

  • if itís minimal, limited, moderate or extensive. On the board exam, they tend to give you the

  • words, the language to plugin.

  • The 3rd column is risk. Risk of complications and or morbidity or mortality. So thereís

  • minimal, low, moderate, or high risk and there is a table of risk that if you Google it,

  • you know, E&M Table of Risk. Itís on the CMS website. It is a set table and it will

  • have a bunch of things listed. Like for example, prescription meds. If a prescription is given,

  • itís automatically a moderate risk, if the physician wrote a prescription. Minimal would

  • be something like go home and gargle or rest, that kind of thing. So you get the idea. High

  • would be like theyíre recommending elective surgery or something like that.

  • So what you do is once you have the words or the levels of DMO, data and risk, we need

  • to do our leveling for 2 of 3. Because when you read the guidelines up above whatve

  • highlighted here, it says, ìTo qualify for a given type of decision making, 2 of 3 elements

  • in table 1Öî which is what weíre looking atÖ ìmust be met or exceededSo letís

  • see how that shakes out.

  • If you havelet me move this over a little bit. Letís say, a multiple for DMO, a limited

  • for data, and a moderate for risk. So, multiple which shows up on the moderate level of complexity,

  • limited which shows up on the low level and moderate, which shows up on the moderate level.

  • So basically, a moderate, low, moderate. We can throw out the lowest. When itís 2 of

  • 3, throw out the lowest code to the next lowest. So weíre going to throw out the limited or

  • the low complexity and that leaves us with moderate complexity Medical Decision Making.

  • So thatís how you could you know, do that on the board exam.

  • If you hadletís just say, a limited high which translates to a low, low, high,

  • we can throw out one of the lows but the next lowest remains a low so itís low complexity.

  • So we can throw out one but not two. And thatís how 2 of 3 you know, leveling works. It works

  • in the Medical Decision Making table and it works with the overall E&M level scoring.

  • So thatís Medical Decision Making in a nutshell there. Thereís more information in your guidelines.

  • So you can see here, determine the complexity of Medical Decision Making and these bullets

  • correspond to those 3 columns that we were just looking at.

  • So DMO is the number of possible diagnoses with the number of management options that

  • must be considered. And remember, Medical Decision Making is whatís going in the physicianís

  • head toÖ after theyíve already taken your history, theyíve talked about review of systems,

  • theyíve done an exam based on that. Now, theyíre going to put it all together and

  • decide what to do about it. Are they going to send you for physical therapy? Are they

  • going to order tests? Is he going to write a prescription? Okay?

  • Data is the amount and or complexity of medical records, tests, or other information that

  • must be obtained, reviewed, and analyzed. So it could be obtained. They might write

  • an order for an x-ray. Thatís data. Or they might review an x-ray in a subsequent visit.

  • Thatís data, okay. Youíll also hear sometimes with phone calls, when a physician will talk

  • to a patient on the phone. If they document that phone call, they canít get credit for

  • it that day. But when they come back for the next visit, if they review that phone call

  • conversation, that can count toward data.

  • And then this third one, risk. The risk of significant complications, morbidity and or

  • mortality, as well as co-morbidities associated with the patientís presenting problems, the

  • diagnostic procedures and or the possible management options. And some of it seems a

  • little duplicative when you look at the Table of Risk and itís like, ìWell, itís talking

  • about diagnoses. Isnít that in the DMO, the number of diagnoses and management options

  • And yes, it is. But when you start breaking it down and doing it often enough, it makes

  • sense.

  • But keep in mind, for the board exam, youíre not going to need to know how to do it from

  • like an auditorís perspective. Now if youíre going for the E&M specialty credential, they

  • let you bring in an audit tool. And I share a really good one on the E&M you know, webinar

  • that you can use in your day to day coding. Itís actually modified from a Medicare webinar

  • I went to years ago. But itís all in one page which is kind of nice.

  • Get more cpc exam tips, medical coding training and CEU credits.

  • Go to www.codingcertification.org

Determining the level of Medical Decision Making.

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B1 中級

医療の意思決定 - E/Mコーディング文書とガイドライン (Medical Decision Making — E/M Coding Documentation and Guidelines)

  • 51 10
    H.J. Lin に公開 2021 年 01 月 14 日
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