Medicare Compliance & Reimbursement - 2013 Issue 6
Key Elements: Follow 3 Tips to Take the Risk Out of MDM Calculations
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Article Overview
This article is a practical overview of medical decision making (MDM) calculation for evaluation and management services. It covers the major MDM components, how documentation is reviewed at a broad level, and how CMS MDM guidance and risk concepts are used to understand overall encounter complexity. The piece is aimed at coders, auditors, and clinicians who need to assess whether documentation supports a given level of service.
Why This Topic Matters
MDM is a core factor in E/M leveling, so understanding how the components are weighed helps support accurate documentation review and code selection. The topic matters to coding and compliance professionals working with physician documentation, auditing, and level-of-service determination.
Article Sections
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Understand Each Level of Diagnosis
Introduces the first MDM component and describes how diagnosis-related information is reviewed at a general level for encounter complexity assessment.
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Classify Your Data Complexity
Reviews the second MDM component and summarizes the broad categories of data activities that can affect complexity determination.
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Weigh the Risk
Explains the third MDM component and discusses how risk is considered using the general subcategories referenced in CMS guidance.
What You Will Learn
- The main components used to evaluate medical decision making in E/M encounters
- How documentation is considered across diagnosis-related, data-related, and risk-related elements
- How CMS MDM guidance is referenced in relation to risk assessment
- Why documentation completeness affects MDM review and level-of-service support
- How coders and auditors approach overall MDM complexity at a high level
Who Should Read This
- Medical coders
- Coding auditors
- Physician compliance staff
- Clinical documentation improvement staff
- Providers documenting E/M services
Codes Discussed
Code Ranges Discussed
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