Dermatology World January 2011 : Page 4

cracking the code BY DIRK ELsTON, M.D. Coding E&M services A SIMPLE GuIDE To MEDICAL DECISIoN MAkING (MDM) CRITERIA DiRk m. ElSTON, m.D., will address important coding and documentation questions each month in Cracking the Code. Dr. Elston, chair of the depart-ment of dermatology at Geisinger Medical Center, represents the American Academy of Dermatology on the AMA-CPT ® Advisory Committee. I tried to learn the medical decision making criteria, but my head exploded after the second table. Do I really need to learn this stuff? In a word, yes. You really do need to learn them, but it’s no harder than learning the porphyrias, and you’ll use the knowledge much more often. In fact, you will use it for every patient encounter, every day, for the rest of your career. I recommend that you tape a simplified version of the Medical Decision Mak-ing (MDM) criteria to your bathroom mirror and read it every day as you brush your teeth. Or, try them with Grape Nuts at the breakfast table. Gradually, they become second nature and the investment will pay you back for years to come. MDM depends on the number of diagnoses or treatment options, risk, and amount and complexity of data. Two of the three are required to establish the level of MDM. As dermatologists, we rarely use amount and complexity of data, so my advice is to skip that one and focus on the other two. A patient with an undiagnosed new problem of uncertain prognosis quali-fies as moderate medical decision making. We’ll walk through the thought process below, but after you determine the level of MDM, you also need to determine the overall level of service for the visit. When determining the appropriate level of service for a new patient, remember that you need three components (history, physical, and MDM). For an established patient, only two of the three are needed, and MDM is usu-ally the easiest of the three to establish. The charts on this page and p. 5 should allow you to simplify your MDM determinations. There is one important exception: TrailBlazer, the Medicare carrier in Texas, Virginia, Maryland, Delaware, and the District of Columbia, uses an alternate MDM point system. Visit www.trailblazerhealth.com/Specialty Services/Evaluation and Management/ default.aspx for more information about this system. dw MDM made simpler 1. DETERmiNE SEVERiTY The number of diagnoses or treatment options is a simple point system. Two points correlates with low MDM and three points with moderate MDM as long as the level of risk also matches that level. PROBlEm Self limited or minor problem (up to two) Established problem, stable or improved Established problem, worsening New problem; no further workup New problem, additional workup planned POiNTS 1 1 2 3 4 CONTiNuES ON PagE 5 » 4 Dermatology WorlD // January 2011 www.aad.org

Cracking The Code

Dirk Elston, M.D.

Coding E&M services<br /> <br /> DiRk m. ElSTON, m.D., will address important coding and documentation questions each month in Cracking the Code. Dr. Elston, chair of the department of dermatology at Geisinger Medical Center, represents the American Academy of Dermatology on the AMA-CPT® Advisory Committee.<br /> <br /> I tried to learn the medical decision making criteria, but my head exploded after the second table. Do I really need to learn this stuff ?<br /> <br /> In a word, yes. You really do need to learn them, but it’s no harder than learning the porphyrias, and you’ll use the knowledge much more often. In fact, you will use it for every patient encounter, every day, for the rest of your career. I recommend that you tape a simplified version of the Medical Decision Making (MDM) criteria to your bathroom mirror and read it every day as you brush your teeth. Or, try them with Grape Nuts at the breakfast table. Gradually, they become second nature and the investment will pay you back for years to come.<br /> <br /> MDM depends on the number of diagnoses or treatment options, risk, and amount and complexity of data. Two of the three are required to establish the Level of MDM. As dermatologists, we rarely use amount and complexity of data, so my advice is to skip that one and focus on the other two. A patient with an undiagnosed new problem of uncertain prognosis qualifies as moderate medical decision making. We’ll walk through the thought process below, but after you determine the level of MDM, you also need to determine the overall level of service for the visit. When determining the appropriate level of service for a new patient, remember that you need three components (history, physical, and MDM) . For an established patient, only two of the three are needed, and MDM is usually the easiest of the three to establish.<br /> <br /> The charts on this page and p. 5 should allow you to simplify your MDM determinations. There is one important exception: TrailBlazer, the Medicare carrier in Texas, Virginia, Maryland, Delaware, and the District of Columbia, uses an alternate MDM point system. Visit www.trailblazerhealth.com/Specialty Services/Evaluation and Management/ default.aspx for more information about this system.<br /> <br /> MDM made simpler<br /> <br /> 1.DETERmiNE SEVERiTY<br /> <br /> The number of diagnoses or treatment options is a simple point system. Two points correlates with low MDM and three points with moderate MDM as long as the level of risk also matches that level.<br /> <br /> 2.ASSigN RiSk lEVEl<br /> <br /> The level of risk is usually just as easy to establish as the number of diagnoses using the risk table below.<br /> <br /> 3.FiNal RESulTS fOR ComPlExiTY<br /> <br /> If both of the above are in the same column, that is your MDM.If they are different, choose the lower of the two.

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