level must not exceed MDM?

What exactly does this mean?

re: level must not exceed MDM?

can anyone explain this?

re: level must not exceed MDM?

the degree of complexity of Medical Decision Making should equal the entent of History and Physical exam noted in CPT® code

re: level must not exceed MDM?

that helps me somewhat but do you have an example, I think that would clarify further for me. Thanks

re: level must not exceed MDM?

Where did you read this?

Take a look at this article and see if it helps.

http://codapedia.com/article_559_Medical-Necessity-is-not-Medical-Decision-Making.cfm

re: level must not exceed MDM?

This isn't something I've read anywhere but something I've heard from a couple different coders.

I read the article and basically what I get out of it is that what the provider has documented doesn't necessarily mean that it can all be counted. Its coders discreation to decide whether or not what is documented warrants a certain level.

re: level must not exceed MDM?

I think the point is, if audited the payor may look at the level of MDM based on presenting problem and other findings during the encounter to justify a certain level of E/M H&P. This is just saying if the decision making is straightforward or low complexity, the coding of a moderate to high level of H&P will raise a flag. It is not saying the coder makes any decision and discounts the physician's level of code. But, if a significant difference between MDM and the H&P performed, the physician could be alerted. It is a guideline and common sense. Remember writing a book does not justify the level, it is what is medically necessary based on the presenting problem(s) and abnormal findings. If the H&P justifies the medical necessity, it should be no problem. The problem comes with documentation that is extensive but the presenting problem is straightforward, self-limiting, or minor.

re: level must not exceed MDM?

I hope I didn't say it was "coders discretion" to decide what counted, because I don't say that and I never would.

I think we coders need to careful in thinking we can override the physicians.

re: level must not exceed MDM?

Totally agree

re: level must not exceed MDM?

I'm not saying that I would override the physician. But anyhow I'm still confused but thanks.

re: level must not exceed MDM?

Do you have an example? That always helps. Or, a citation that states this. I see that other coders have told you this, and fellow coders are a great resource.

There are many articles on Codapedia about E/M coding.

re: level must not exceed MDM?

(Low complexity MDM) billed with a 99214 or 99215 CPT® code. The MDM process would not require a detailed or comprehensive H&P.