Telemedicine Update, April 10

April 10, posted on NANOSnet

Date:    Fri, 10 Apr 2020 10:41:37 -0400
From:    Kevin Lai
Subject: Billing video telemedicine based on medical decision making alone!!

Hey everyone,

I mistakenly posted the tables for the new medical decision making (MDM) criteria (taking place in 2021), but the MDM criteria being used for billing video telemedicine visits is actually the existing MDM. Heather Moss kindly shared the tables she uses for calculating MDM:

MDM is based on the highest 2 of 3 aspects (diagnosis, data, risk).

Diagnosis Points table                                                                                                    Data Points Table

Diagnoses

Points

 

Data

Points

Self-limited or minor (max 2)

1

 

Review/order clinical lab tests

1

Established problem stable or improving

1

 

Review/order x-rays

1

Established problem, worsening

2

 

Review/order medical tests

1

New problem, no work up planned (max 2)

3

 

Discuss results with performing physician

1

New problem, additional work up planned

4

 

Independent review of image

2

Diagnosis points = sum from above table

Data points = sum from right table

 

Decision to obtain old records

1

 

Review and summation of old records

2

Medical Decision Making Levels

 

Level (CPT)

(new, consult or established)

Diagnosis

(points,

see table)

Data

(points,

see table)

Risk (highest of 3 columns)

(relevant to ophthalmology & implied though not documented anywhere)

problem

Procedures ordered (examples)

Management

(examples)

Straightforward

1,2

1 point, eg.

·  Self limited or minor

·  Established problem, improving

1 point, eg.

·  Order a test

or

·  Review a test result

1 self-limited or minor problem

·   Venipuncture

·   Ultrasound

·   Ophthalmic photography without contrast

 

·   Rest

·   Bandages

·   Superficial dressings

·   Compresses

Low

3

2 points, eg.

·  Established problem worsening

2 points, eg.

·  Decide to obtain old records and order an imaging test

or

·  Order a lab test and an imaging test

·  2+ self-limited or minor problems;
or

·  1 stable chronic illness
or

·  1 acute, uncomplicated illness or injury

·   Imaging study with contrast

·   Fluorescein angiography

·   Physiologic tests not under stress

·   HVF

·   Superficial needle biopsies

 

·   OTC drugs

·   Artificial tears

·   Minor surgery without risks

Moderate

4

3 points, eg.

·  New problem, no work up

 

3 points, eg.

·  Review an MRI report and review the image

or

·  Review lab and imaging test and decide to obtain old records

·  1+ chronic illness w/exacerbation, progression, or side effects of tx
or

·  2 or more stable chronic illnesses
or

·  1 undiagnosed NEW problem w/uncertain prognosis
or

·  1 acute illness with systemic symptoms
or

·  1 acute complicated injury

·   Obtain fluid from body cavity

·   Deep needle or incisional bx

·   Prescription drugs

·   Minor surgery with risks

·   Elective major surgery without risks

High

5

4 points, eg.

·  New problem, additional work up planned

or

·  New problem, no work up + established problem stable or improving

4 points, eg.

·  Order a lab test, order an image test and review and summarize old records

·  1+ chronic illnesses with severe exacerbation, progression, or side effects of treatment
or

·  1 acute or chronic illness that poses a threat to life or bodily function

    or

·  Abrupt change in neurologic status (eg. Sensory loss)

 

·   Parenteral controlled substances

·   Elective major surgery with risks

·   Emergency major surgery

------------------------------

Date:    Fri, 10 Apr 2020 13:35:53 -0400
From:    Kevin Lai
Subject: Re: Billing video telemedicine based on medical decision making alone!!

For those wanting the direct from CMS source:

https://cms.gov/files/document/covid-final-ifc.pdf

Page 136-137
 

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