• My Account
    • Login
  • Contact Us

CodingIntel

Medical coding resources for physicians and their staff. CodingIntel was founded by consultant and coding expert Betsy Nicoletti.

  • Join Today
  • What is CodingIntel
    • About
    • Become a Member
    • FAQ
  • Free Resources
    • Free Resources Overview
    • Blog
    • Everyday Coding Q&A
    • Newsletter
    • Can I get paid
  • Coding Library
    • E/M Changes
    • How Physician Services Are Paid
    • In Person E/M
    • Prevention & Screening
    • Care Management & Remote Monitoring
    • Surgery, Modifiers & Global
    • Diagnosis Coding
    • New & Newsworthy
    • Speciality
    • Practice Management
  • Webinars
    • Webinars
    • Coding Guides
    • Quick Reference Sheets

The second element of MDM: amount and/or complexity of data

  • There are three elements in medical decision-making and this article describes the second, arguably, the most complex of the three elements
  • When selecting a level of service based on medical decision-making two of the three elements are required
  • CPT® has developed definitions for many of the components in the MDM chart and this article describes the definitions and rules related to data
  • Data, and crediting data, has been anything but simplified and straightforward. Although the physicians on the AMA committee may describe it as intuitive, it doesn’t seem that way to those of us trying to interpret it.

This post includes:

  • Quick reference sheet Credit for tests in the data element
  • A brief video summary with downloadable slides
  • Definitions related to data in the new MDM chart for office E/M visits in 2021
  • Selecting the level of data using the new MDM chart for E/M services in 2021

Login to read the rest of this article


Don’t have a login? Become a member, or learn more about the benefits of membership by clicking on the link below.

Get Unlimited Access to CodingIntel’s Online Library

Are you a coder, biller, administrator,
office manager or physician?

Learn more about the benefits of
a CodingIntel membership

click here!

Relevant Search Terms: E/M changes 2021, CPT and CMS amend rules

CPT is a registered trademark of the American Medical Association Copyright 2022, American Medical Association All rights reserved.

Last revised January 17, 2022 - Betsy Nicoletti
Tags: E/M medical decision making

Comments

  1. Jae Hettick says

    August 3, 2020 at 3:07 pm

    Betsy, Just so I’m clear on this: In “Definitions related to data” toward the beginning of this article, you state, “There is separate counting for ordering and for reviewing the unique test”. Does this mean, for instance, if the provider orders 81002 and records the results in the documentation, that the provider gets credit for ordering 81002 and gets additional credit for reviewing and recording the results? I hope this is the case as otherwise our data scores are frequently going to be very low when only one test is required.

    • Betsy Nicoletti says

      September 2, 2020 at 7:45 am

      You can take credit for ordering the test, but not interpreting the results because you are billing for it. That is, it is separately reported. That is how I am interpreting these guidelines.

Wondering about the rules for HCC coding?

Wondering what the rules are for HCC coding, and where you can find them? This video answers your questions. The topic is important to medical practices because risk-adjusted diagnosis coding is part of Medicare Advantage contracts, many commercial contracts and Accountable Care Organizations (ACOs). Sign up for our monthly newsletter to download the whitepaper and watch the video.

Sign Up Now

Recommended Resource

You’ve coded it, but you still have to fight to get paid! We’ve partnered with Elizabeth Woodcock to give you the tools and strategies you need.

Find them here!

Latest Intel

Coding Principles for Practice Administrators | Webinar

Coding Principles for Practice … Read More...

CPT Coding for Obstetrical and Gynecological Procedures | Webinar

Who Runs the World? GIRLS!!: CPT Coding for … Read More...

Payment denials for unspecified codes

From the day coders got their first glimpse at … Read More...

Behavioral health coding compliance

Compliance Lessons from the OIG In March 2022, … Read More...

Browse By Categories

Browse Content

  • Articles
  • Coding Guides
  • Everyday Coding Q&A
  • Videos
  • Can I Get Paid to
  • Blog
  • Webinars

Tags

behavioral health_cpt codes behavioral health_E/M services care management category of service CMS updates Code sets and reimbursement compliance issues CPT codes for preventive services CPT updates critical care services dermatology_E/M services dermatology_essential resource dermatology_procedures E/M frequency data E/M medical decision making E/M overview E/M reference sheets E/M rule changes FQHC general surgery_diagnosis coding general surgery_E/M services general surgery_modifiers general surgery_procedures global surgery issues HCC diagnosis coding ICD-10 coding level of service_MDM level of service_time medicare incident-to and shared services minor procedures modifiers other E/M services Preventive and problem visits preventive services for medicare primary care_diagnosis coding primary care_E/M services primary care_essential resource primary care_modifiers primary care_other E/M services primary care_preventive services primary care_procedures remote physiologic monitoring screening and counseling for behavioral conditions teaching physician rules telehealth
  • What is CodingIntel
  • FAQs
  • Terms of Use
  • Privacy Policy
  • Contact

Our mission is to provide accurate, comprehensive, up-to-date coding information, allowing medical practices to increase revenue, decrease coding denials and reduce compliance risk. That's what coding knowledge can do.

In 1988, CodingIntel.com founder Betsy Nicoletti started a Medical Services Organization for a rural hospital, supporting physician practice. She has been a self-employed consultant since 1998. She estimates that in the last 20 years her audience members number over 28,400 at in person events and webinars. She has had 2,500 meetings with clinical providers and reviewed over 43,000 medical notes. She knows what questions need answers and developed this resource to answer those questions. For more about Betsy visit www.betsynicoletti.com.

Copyright © 2022, CodingIntel
Privacy Policy