tci Medicare Compliance & Reimbursement - 2015 Issue 8

Industry Notes: This MAC Spells Out 'High Risk' MDM Component

If you’re trying to achieve a higher medical decision-making (MDM) level because your patient gets insulin drips, your documentation must include specific criteria or your “high risk” MDM could be out the window. That’s the word from Palmetto GBA’s recent “E/M Weekly Tip,” which the MAC posted on March 24. “An intravenous insulin drip is considered ‘high risk,’” Palmetto says. “To consider therapy with one of these drugs as a high risk management option, we would expect to see documentation in the medical record of drug levels obtained...

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