" Discussion Of Case With Another Health Care Provider " and CMS Definition of Health Care Provider

Trying to code everyevaluation and management (E/M) visit correctly, every time, is difficult. Why? Because Medicare, by default, established rules which were vague and open to interpretation. While not a product of CMS, the Marshfield Clinic audit tool is used by many Medicare carriers to help define the medical decision making component of the E/M rules as low, medium or high. These rules are complicated. After a decade, I still use a bedsideE/M reference card I created as a reference to try and help me get my correct level of care every time.In the medical decision making (MDM) component of E/M coding there are  three  components, the highest two of which determine the overall MDM.  These are the diagnosis, data and risk.  Within the data component includes the statementReview and summarization of old records and/or obtaining history from someone other than patient and/or discussion of case with another health care provider If you document " discussion of  case with another health care provider " this documentation will provide you with 2 points in the data section of medical decision making. If you call up the GI doctor and tell him about the new consult or if you call the PCP to talk about aspects of the patient ' s care, remember to document that you had this discussion and what you discussed and the Marshfield Clinic audit tool will give you two points in the data section of medical decision making.  Under coding is also fraud.No wher...

Source: The Happy Hospitalist - September 3, 2012 Category: Internal Medicine Authors: The Happy Hospitalist Source Type: blogs