Welcome back to the Compliance Blog!
We are happy to have you here for the January 2024 Compliance Blog! This month, we are giving you a peek behind the Medical Coding Curtain and talking again about Evaluation and Management visits. Buckle up for the fun!
Let’s talk medical coding!
In our first two coding-related blog posts, we discussed E&M coding and how it attempts to assign a level of risk to a patient visit. This month, we’ll talk about how labs ordered or reviewed at the time of the visit can influence the E&M level of that visit.
Breaking it down further:
As stated before, the level of Medical Decision Making (MDM) isn’t determined by the patient’s condition alone; it’s also determined by how you treat that condition. If these two levels of risk are different, you’ll use the E&M code corresponding to the lower of the two. However, if you are deferring treatment to wait on diagnostic labs ordered at the time of the visit, then those labs can replace the “treatment” risk when calculating the code level. Two unique diagnostic labs can support a level 3 visit for which no medications are yet recommended, and three labs would support a level 4 visit.
Typically, the ordering or reviewing of labs wouldn’t change the level of E&M code you would use to describe a visit, as either medications are prescribed or over-the-counter (OTC) drugs are recommended for most issues, but for the occasional visit where you’re waiting on labs to determine if you need to change the dosage of a medication or to choose between antibiotics based on a lab culture, these labs can make a difference!
We are Here to Help!
If you have any questions about any of these, please feel free to reach out to our Medical Coder, Lena Sadler, via Teams and/or email at LenaSadler@healthpoint-tx.com.