Which option is NOT a valid component of the MDM framework as described, and could serve as a distractor?

• A. The use of problem count to determine E/M level
• B. Review of external notes in Category 1 MDM
• C. The global period is 90 days
• D. Inclusion of preoperative counseling as a separate, billable service

Answer: (D)

The main idea being tested is what factors determine the Medical Decision Making (MDM) level. MDM is built from three elements: how many problems are addressed and how complex they are, the amount and complexity of data reviewed (such as external notes), and the risk of complications, morbidity, or mortality.

In this framework, using the number and complexity of problems to set the E/M level is a direct, foundational component. Similarly, reviewing external notes or other data sources fits into the data reviewed aspect of MDM. The option about a 90-day global period is a separate billing concept tied to perioperative care and does not define MDM itself, making it a distractor but not part of the MDM scoring.

The statement describing preoperative counseling as a separate, billable service does not feed into any of the three MDM axes (problem count, data reviewed, risk). It may be billable in some contexts, but it isn’t a component used to determine MDM level, so it’s not part of the MDM framework. That’s why it’s the best choice for not being a valid component of MDM.