MDM Calculator

For those who missed it, I posted a link to the free MDM Calculator to reflect the 2021 E&M changes. You can find it here:

Free E&M Medical Decision Making Calculator




Thank you for sharing this amazing tool. Love it.

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Does any of this template change with the AAP update/guidance that tests ordered/interpreted can not be counted?

Technically, no - the “calculator” doesn’t change, just our understanding what and when you should indicate whether you have ordered a test, etc.

Personally, the update from the AAP doesn’t make sense to me for a variety of reasons and I think there is some more for us to work out and understand before all is settled.

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This is fantastic!

Rad! Thank you for sharing.

Thank you for sharing this tool. The providers here will be psyched!

Hi Chip!

We are getting a lot of push back from our providers on this update.  I don't understand the "logic" behind not allowing labs billed in house to be counted towards your MDM, so it's hard for me to then explain the reasoning to our providers.  This was from one of our doctors:

“If I do a bili, CBC or culture in house or send it out, the medical decision making is the same. Maybe the spirit of the AMA guideline is based on the common osha waived labs like simple rapid strep or dipped urines, those are more simple—add the actual culture reading and MDM steps up a notch. Most outpatient offices don’t have a more complex, CLIA certified lab like we do.”

Are you able to speak into this? Is it different for simple labs run in-house, versus if we have a high complexity lab where we run labs in-house?

Another one of our NPs said she read on a provider thread that if we billed for the lab and also counted the ordering and/or reporting in our MDM level, we would be “double dipping.” I don’t agree with this thought process though. We get paid for the labs we run in house, but that is to cover the cost of running the lab, the cost of our analyzers/machines, the cost of our phlebotomists and lab team members, however this doesn’t reimburse us for the providers’ interpretation of the results or take into effect that they are going to be making a decision on the patients’ care based on the results. Also, interpretation & report is not included in the definition of a lab CPT code, the way it is for say a depression screen.

I guess it doesn’t make sense to me why the providers’ medical decision making is “reimbursable” when labs, x-rays, tests are sent outside of the practice, but their decision making is not “reimbursable” when those same tests are run in house.

I just wanted to get your thoughts/feedback and see if we are misunderstanding this update, or if our assumptions are off-base! I really appreciate your help!! Thank you!

Right now, the guidance from the AMA says that if any order you give that you also can bill for (strep, CBC, MCHAT, you name it) cannot also be used for the MDM “counting” purposes.

On one hand, there is mild logic to this. I’m not saying it’s thorough, just somewhat understandable. In THEORY, the “effort” (in terms of time, expertise, MDM, etc.) for both ordering and reading a test is included in the RVU values for that test.

The consequence, however, are somewhat disastrous. This will just encourage clinicians to order MANY more third-party tests. It also gives little or no credit for NOT ordering tests (but there’s a solution to that, imo).

We’re hoping for clarification soon.

Looking for clarification as we begin to use the new 2021 E&M guidelines.

I had a physician who saw a patient for warts. The mother was the historian. He discussed cryotherapy and the procedure was performed. He wrote a prescription for a cream for the warts. Instructions were given for care of the sites. I have a couple of questions about how to code this visit.

Is the warts diagnosis a self-limited, minor problem (99212) or an acute, uncomplicated illness (99213)? It was a new problem that was not improving without treatment.

*Does the cryotherapy order fall? I am guessing because the CPT code is minor surgery that it falls under the risk section.

According to the MDM chart, it appears there is moderate risk for this visit because a prescription was given and cryotherapy was discussed. Is that correct?

Based on which way the answers fall above, this visit could be a 99212 or a 99213. Thanks for the help!

Can you give any insight into how this issue affects allergists? All their tests are going to be performed in house. They would not ever send out their testing to be performed elsewhere. Thank you!

We are ALL awaiting confirmation from the AMA (and, in our case, the AAP). Do you know anything from the allergist groups?

I’m not quite sure if you are asking me this question, but I work for a multi-specialty practice that includes an allergist. We are asking this question, because we are unsure how this in house ordering and review of tests not counting towards MDM affects us in allergy. :wink:

Yes, I was asking you :slight_smile:

I was wondering if any of the specialty societies that represent the other specialties in your group have learned anything? Although pediatricians are affected by these changes, they aren’t as affected profoundly yet as other specialties, especially those that take Medicare!