# Moderate vs. High Severity MDM?



## 1071471 (Mar 30, 2009)

The patient is currently re-admitted for "Problable eosinophilic gastroenteritis but must rule out parasitic disease of the GI tract, s/p biventricular pacemaker change."

Would you consider this : (1) Undiagnosed New Problem - Moderate or (2) Acute or Chronic Illness that may pose a threat to life or bodily function -High?


I am on the fence with both of the options, and MDM is the driving factor behind the level of service.

Your thoughts, comments are well appreciated!


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## Lisa Bledsoe (Mar 30, 2009)

I would be inclined to think of this as an undiagnosed new problem.  This sounds like a GI doc doing the admit?  So what would be the connection to the biventricular pacemaker change?  Without more info on the pacemaker, I don't see the connection.  Just my thoughts.


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## 1071471 (Mar 30, 2009)

This is an infectious disease MD who has been consulted by the Cardiologist  (admitting MD)who performed the pacemaker change. GI is also working the case in trying to determine the cause of the patient's severe eosinophilia by performing an endoscopy and biospy.

The Infectious disease MD is recommending ECG to rule out endocardial lesions, and also disontinuing Flagyl and levofloxain, obtain stool samples, quantitive immunoglogulin in IgE levels.

Your thoughts??????


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## Lisa Bledsoe (Mar 30, 2009)

I see your dilemma now...

So, is this:
 A) a  mild side effect of the treatment (s/p biventricular pacemaker) = mod
 B) an undiagnosed new problem with uncertain prognosis = mod
 C) a severe side effect of the treatment (s/p pacemaker) = high
 D) an acute illness that may pose a threat to life or bodily function = high

Is this new condition a side effect from the surgery?
How severely does it effect bodily function?  (I am not familiar with infectious disease).  I might lean more towards "D" based on my limited knowledge of this specialty...


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## ARCPC9491 (Mar 30, 2009)

Problable eosinophilic gastroenteritis but must rule out parasitic disease of the GI tract, s/p biventricular pacemaker change."

Here's my take. I don't think eosinophilic gastroenteritis poses a threat to life. It's swollen/ulcerated tissue and typically improves by diet changes. The parasitic infection could very well be the cause. Most parasitic infections aren't life threatening. _they can be -_ depending on the type, but your doctor doesn't know as their just obtaining the stool samples to find out, I would go with "undiagnosed new problem" and when you definitely find out, use that for the next encounter. 

Just my 2 cents..


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## FTessaBartels (Mar 30, 2009)

*Not high risk*

I would not consider this life-threatening ... at least it doesn't seem to be documented as such. 

But you clearly have Rx drug management (moderate risk) - or undiagnosed acute problem (also moderate risk)

You also have a new problem w/ addl workup planned (4 problem points)

While I can't tell from the limited info you posted -* If* you have *4 data points *you would get a High MDM.

If you have 3 or fewer data points you are back to Moderate MDM.

F Tessa Bartels, CPC, CEMC


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## 1071471 (Mar 30, 2009)

*Moderate risk*

Thanks everyone...I'm thinking Moderate risk is more appropriate based on the feedback.


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