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E & M

Heidi Posted Wed 22nd of February, 2017 09:13:18 AM
When auditting a 99232 I know we can use 2 out of the 3 components but does the MDM have to be one of the components in the guidelines it only states 2 out of the 3 but I've been always told that the MDM has to be one of the two
SuperCoder Answered Thu 23rd of February, 2017 08:14:40 AM

99232 is a subsequent hospital care, per day, for the evaluation and management of a patient, which requires at least 2 of these 3 key components: 1. Expanded problem focused interval history. 2. Expanded problem focused examination. 3. Medical decision making of moderate complexity. It is not necessary that MDM has to be one of the two.

Heidi Posted Thu 23rd of February, 2017 16:26:45 PM
What about observation codes do they have to have MDM as one of the main component?
SuperCoder Answered Mon 27th of February, 2017 06:55:08 AM

For observation codes also It is not necessary that MDM has to be one of the main component.

Heidi Posted Mon 27th of February, 2017 10:00:05 AM
then why does it state in the CMS guidelines the code has to support the medical necessity of the visit and you get that from your MDM
SuperCoder Answered Tue 28th of February, 2017 09:38:02 AM

As per CMS requirement of medical necessity from MDM is correct statement for generalise E&M rules. But when it comes to a specific section where MDM is not considered there you can take medical necessity from HPI, because present illness makes the risk level in the MDM table.

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