ED Coding & Reimbursement Alert - 2022 Issue 9
Reader Questions: Don’t Count on a Referral to Determine MDM
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Article Overview
This reader Q&A discusses how referral to another provider fits into Evaluation and Management documentation and medical decision making (MDM). It is aimed at coders, billers, and clinicians who work with E/M services and need to understand how the MDM table is evaluated in context. The article covers general MDM concepts, the role of risk, and how the three MDM columns are considered together when determining the level of service.
Why This Topic Matters
Correctly understanding how referral decisions affect MDM helps support accurate E/M leveling and consistent documentation review. The article clarifies a common misconception about referrals and explains why the full encounter context matters.
What You Will Learn
- How referral decisions relate to MDM in E/M services
- Why MDM is assessed using the full encounter context
- How the three MDM table columns are considered together
- Why provider work and patient circumstances matter in the MDM assessment
Who Should Read This
- Medical coders
- Medical billers
- Clinicians documenting E/M services
- Compliance and auditing staff
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