# MDM High Complexity ?



## mcarrillo (Jan 18, 2012)

Hi,

One of the docs selected high complexity for the MDM on a new pt with a history of metastic breast disease and comes in for a surgery consult on a new adrenal mass with a high intake on a PET. He recommends total adrenalectomy, and explains the risks and benefits of the procedure to the patient- (_The risk and benefits of the procedure were discussed include bleeding, transfusion of blood or blood products, infection, the need for conventional adrenalectomy, injury or regional structures including liver, vena cava and right kidney, recovery expectations, experience of the operative procedure, hazards associated with anesthesia._)

Does this meed the high complexity? Does it meet high on the Level of Risk chart? I'd really appreciate any opinions, explanations on this.

Thanks


----------



## FTessaBartels (Jan 23, 2012)

*Moderate Risk*

From the brief excerpt you provide, I get moderate risk for the PROCEDURE.
Ellective Major Surgery *with no *identified risk factors

The risk factors the table is referring to are patient co-morbidities, NOT the risks of the surgery/procedure.   So if the patient has DM, for example, or is on coumadin, or has a congenital heart anomaly ... those are identified risk factors. 


HOWEVER ... it is possible he is looking at the metastic breast disease with a new adrenal mass as  "*One or more chronic illnesses with severe exacerbation, progression or side effects of treatment." *.  This would fall under high risk. 


Hope that helps.

F Tessa Bartels, CPC, CEMC


----------



## mcarrillo (Jan 23, 2012)

Thank you F Tessa. This helps out a lot.


----------



## dimmitta (Jan 25, 2012)

Tessa is correct that the Table of Risk for MDM is referring to co-morbidities. Something else to consider when dealing with Oncology patients, besides chronic conditions such as DM, are the chemo drugs the patient is currently taking in treatment. When a patient who is on chemotherapy is going to have surgery we usually consider the patient high risk because of all the side effects of the chemo, such as, drug induced neutropenia, abnormal lab counts, anemia, kidney disease, etc. Something to think about!


----------

