Our pediatric genetics division regularly orders whole genome testing as part of E/M services, with physicians obtaining patient consent. While our physicians receive credit in medical decision making (MDM) for ordering and reviewing these tests, they believe that performing whole genome testing-and the potential implications for patient management-should also be considered under the "Risk of Complications and/or Morbidity or Mortality" category. Specifically, they feel the risk associated with whole genome testing is comparable to prescription drug management. Can you clarify if this is something that can be counted under the risk category? ...
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Article Overview
This brief coding guidance article addresses evaluation and management medical decision making for pediatric genetics visits involving whole genome testing. It is written for clinicians, coders, and billing staff who need to understand how test ordering and review are considered in MDM and whether the testing scenario fits into the risk component of the MDM framework. The article presents a direct clarification on where this type of testing is considered in the overall E/M documentation review.
Why This Topic Matters
Correct MDM attribution affects E/M level selection and documentation consistency. This is especially relevant in genetics practices where advanced testing may be part of routine care and could be mistakenly placed in the wrong MDM category.
What You Will Learn
- How whole genome testing is considered within E/M medical decision making
- Which part of MDM may account for ordering and reviewing genetic testing
- Why the testing scenario is not treated the same as prescription drug management
- How the risk component of MDM is addressed in this context
Who Should Read This
- Physicians
- Medical coders
- Billing staff
- Genetics practices
- Compliance staff
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