# E/M for Oncology



## linda s (May 2, 2009)

Can someone comment on how they are evaluating the level of MDM for oncology patients?  Typically, for follow up visits it is an established condition that is stable or improving.  The physician mentions side effects, however, these cannot be counted as separate problem can they?


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## gothgirl44 (May 2, 2009)

*oncology*

99214, the side effects are not a new problem, they are part of the same problem. side effects do not last long enough to be considered a new problem. Cancer patients usually have a multiple problems associated with the cancer anyway. The side effects would be a new problem if they persist then there is another underlying problem.


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## lavanyamohan (May 3, 2009)

Hi,
A : Treatment Options -
     Established problem: stable, improved  - Point 1;
B : Amount of data -
     Decision to obtain old records and/or obtain hitory from someone other   
     than patient, if done - point 1;
     Review and summarization of old records, if done : points 2;
     Review  and/or order of tests in Medicine section, if done: point 1;
C : Risks and complictions and/or co-morbidity level - 
     For follow up in oncology is moderate usually;

With A as 1, B say 3 and comorbidity levels not very high, MDM can be moderate;
99213 can be coded if comborbidity levels are low; When they say stable, it implies risk factors are less and this can fall to 99213;
99214 if moderate-high risk factors like hemophilias, post-surgical anemia and dysplasias continue; This can be patient with new problems - A :3 minimum;
LM


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## Karolina (May 4, 2009)

The MDM depends on several considerations. You should be able to give a point for each problem the provider has to consider. For example, if the patient is receiving chemo for - let's say - breast Ca and the drug of choice has a higher risk of causing heart problems and your patient already has an underlying heart condition you should be able to give credit for the heartcondition, because it needs to be considered when determining which (and how much of) chemo drug to administer. Of course, your documentation has to reflect on this. Or if the patient has a reaction to the medication that needs to be addresses separately, for example chemo causes neuropathies and now the patient is evaluated for those and gets another medication to treat the neuropathy, then you should give credit for this problem as well. Also, if your providers talk about the patient (which they are likely doing) and document that a conversation took place, that is worth 2 points in the data section. On the table of risk, if a patient is on chemo and is monitored for drug reactions etc. then this could support a high risk, same goes for clinical trials. 
Hope this helps.


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