Medical decision making, this is from one of our Blitz video customers. “Hello, very helpful EM video but I noticed that you didn’t emphasize to write the CMS Risk Data Table for medical decision making in the CPT book. Is it because there’s a simpler way to figure out the level of MDM or is it because the level of examination and determining the PFSH are the only things you need to figure out the correct code?”
So E&M coding has evolved on the board exam. The CMS risk, I put a hyperlink here to show you what that looks like. This is the Table of Risks. And yeah, if you want to write that in your manual, go ahead. You can write anything you want in your manual. You can’t print this and tape it. That is not allowed. The reason why I don’t recommend it is because there is a table that I believe that they will use more on the board exam so let me show you now that I got my document camera working.
Medical Decision Making – Table of Risk Video
What I teach my students or those that purchased the E&M CEU Webinar is to locate your HEM in time is my little rhyme here. So where’s my little pointer? Okay, well I had my nails done so I can use my fingers. Okay so you have Locate Your HEM in Time so H is history, E is exam, M is medical decision making. So on the board exam, your job is trying to pull out that information from the note. You know, what is the level of history? What is the level of exam? What is the level of medical decision making? So this questioner is asking specifically about the MDM. So on this page 3, what I’ve done is I’ve written in some tables that I do encourage you to write. Okay but the medical decision making table is actually a copy of what’s already in your manual on page 10.
Okay so let me show you just so that you see with your own peepers. Alright so here it is printed in the manual. Okay and so what I did is I just drew some columns. So it’s real clear that we’re dealing with 3 separate pieces of medical decision making. We’ve got the DMO piece – diagnoses and management options. We’ve got the data piece and then we’ve got the risk piece. So this risk piece is when you do auditing, they use that table of risk that I just showed you and that backs into these levels. That’s getting to the nth degree of difficulty. And it’s my experience that they don’t do that on the board exam unless they’ve recently changed. They might not tell you it’s straightforward low, moderate or high which we want to you know, do to put into my little Locate Your HEM in Time technique. But they might tell you it’s limited DMO, it’s moderate data and it’s low risk. And then you need to pull up those pieces together using this table that already exists in the book.
So this table is saying 2 of 3. So you can have… and I got that from… over here, in the guidelines. It says, “To qualify for a given type of decision making, 2 of the 3 elements must be met or exceeded.” So if you had a… I forgot what I said. If you have a limited moderate low, you can throw out one of them but the limited and low is going to bring you down to a low complexity.
Now if I said limited, moderate, moderate, then we can throw out the limited because it’s 2 of 3 that we need to meet or exceed. So it’s moderate moderate, it’s a moderate complexity. Okay so for the risk, we don’t need to use that detailed table. We can just use the table they give you in the CPT manual. Now if you’re going to become you know, an E&M auditor, yes you need to know the table of risk. You need to have that handy as a reference tool. If you’re going to take the E&M specialty exam which I’m doing the end of September, by the way so wish me luck, then you can bring in those reference materials. You don’t have to write it in your book. You’re allowed to actually bring it in. So keep that in mind.
And so this table now, we can see minimal, low, moderate, high. So this is just getting even more detailed, more granular. You do not need that for the CPC board exam. If you do then I’ll eat my hat. And if you do, it will probably be one of the 10 questions and I still doubt it. I have not heard that that’s been happening. That would be like having to learn VIR coding – Vascular Interventional Radiology to take the CPC exam. They might ask you some things about families of arteries but they’re not going to… you’re not being tested on being a super detailed coder in every single specialty. They want you to have a broad base of knowledge.