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Mastering medical decision-making: Tips from a coding pro

Selecting a level of medical decision-making (MDM) can be confusing and complicated. There are four levels of MDM: straightforward, low, moderate and high. Each level includes three components that, when used together, determine a level of service.
 
In the June 30, 2025, issue of Part B News, Terry Tropin, MSHAI, RHIA, CCS-P, an AHIMA-approved ICD-10-CM/PCS trainer, laid out a roadmap for accurate and successful MDM use.
 
As Tropin relays, within each level, the three components include specific elements required to report that level. The components encompass:
  • Component 1: Number and complexity of problem addressed
    • This component includes elements for severity and number of illnesses or injuries. Consider the likely severity of the condition, regardless of the final diagnosis. For example, a provider may evaluate a patient with chest pain. The final diagnosis may be muscle strain, but it could have been a heart attack. Therefore, a high level of this component may be justified.
  • Component 2: Amount and/or complexity of data to be reviewed and analyzed
    • This component includes levels for the data obtained, ordered, reviewed, and/or analyzed in order to determine a diagnosis or treatment option for the patient. The straightforward level includes only minimal or low amount of data.
  • Component 3: Risk of complications and/or morbidity or mortality of patient management
    • This component includes elements for the possible risk to the patient from any proposed treatment or additional testing. The straightforward and low levels include minimal or low risk.
Tropin provides several tips for coders working through MDM selection:
  • If two of the three components are at the same level, use that level. For example, if documentation indicates components 1 and 2 are at a low level, it is not necessary to determine a level for component 3 since only two components are needed. In that case use a low level of MDM.
  • If each component is at a different level, use the level in the middle. For example, documentation indicates component 1 is straightforward, component 2 is low, and component 3 is moderate. Use a low level (the one in the middle). The coder may round down (from moderate to low risk) but not round up (from low to moderate complexity of data).
  • If a single component includes multiple elements at different levels, use the higher level. For example, documentation indicates a patient’s risk (component 3) includes both minor surgery without identified risk (low complexity) and drug management (moderate complexity). Use a moderate level of risk.
For additional tips and guidance, you can access the full story here (subscription required).
 

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Blog Tags: E/M services
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