Medicare Compliance & Reimbursement - 2014 Issue 22
E/M Coding: This Payer Clarifies 'New Problem' From MDM Perspective
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Article Overview
This article discusses evaluation and management coding from the medical decision making perspective, focusing on how one payer clarified the meaning of a new problem for diagnosis and management options. It is aimed at coders and billing staff who need to understand MDM component scoring, general assessment concepts, and how payer guidance can affect office visit level selection.
Why This Topic Matters
MDM is a core driver of E/M leveling, and misunderstanding how a new problem is categorized can affect documentation review and code selection. The article is useful for practices that want to align their internal E/M review process with payer guidance.
Article Sections
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Background
Introduces the role of medical decision making in E/M level selection and outlines the three broad MDM components used in assessment.
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Understand Each Level of Diagnosis
Reviews the diagnosis/management options portion of MDM and discusses how problem type is considered within that component.
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Example
Provides an illustrative office-visit scenario showing how different problem categories may appear in a single encounter.
What You Will Learn
- How MDM fits into evaluation and management leveling
- The three broad components of medical decision making
- How payer guidance can clarify the concept of a new problem
- How diagnosis/management options are addressed at a high level
Who Should Read This
- Medical coders
- Billing staff
- Compliance teams
- Practice managers
- E/M auditors
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