FAQ #15
       
Where did the MDM points come from?

Answer: The MDM point system is not contained anywhere in the 1995 or 1997 E/M guidelines. This system was developed at a place called the Marshfield Clinic where the E/M guidelines were tested. Auditors realized that the official MDM rules were too vague and so they came up with the MDM point system.

This MDM point system was refined over the years and was eventually distributed to all Medicare carriers to be used on a "voluntary" basis. In point of fact, the MDM point system has become the de facto standard for measuring E/M cognitive labor and is used by most Medicare carriers and virtually all academic institutions.

Incidentally, Medicare carriers are also allowed to develop their own protocols for quantifying the key component of medical decision-making. So far (thank goodness) only one carrier (TrailBlazer--see FAQ 16) has done this. There is legitimate debate about whether individual carriers should be given the right to fragment the rules for a federally funded program which is supposed to be administered uniformly throughout the country.