Wiki 2021 Complexity of Problems Addressed

terribo

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We have had a few questions from providers in regard to the following definitions listed under the section Number & Complexity of Problems Addressed
1. Chronic illness with exacerbation, progression, or side effects of treatment
2. Chronic illness with severe exacerbation, progression, or side effects of treatment

Per the definition from the AMA for the above problems:
!. Chronic illness with exacerbation, progression, or side effects of treatment: A chronic illness that is acutely worsening poorly controlled or progressing with an intent to control progression and requiring additional supportive care or requiring attention to treatment for side effects, but that does not require consideration of hospital level of care.

2. Chronic illness with severe exacerbation, progression, or side effects of treatment: The severe exacerbation or progression of a chronic illness or severe side effects of treatment that have significant risk of morbidity and may require hospital level of care.

The question I am having from our Orthopedic Specialist: What problem(s) will constitute significant risk of morbidity and may require hospital level of care from an Orthopedic standpoint? What scenarios will the problem "Chronic illness with severe exacerbation, progression, or side effects of treatment" fall under for the Orthopedic Specialty?
 
Hi

I did some asking around, and got one of my experts to weigh in on your question. Please use this info only as a guide and consult with your payer before filing any claims. Thanks!

Best
Chris Boucher, MS, CPC
Senior Development Editor

ANSWER
"Orthopedics is such a large specialty that I'm not sure my suggestions will necessarily fit any specific practice but here are a few possibilities.
Osteoporosis with progression to new fracture or vertebral collapse
Degenerative arthritis that has progressed to need for joint replacement
Non-union of fracture requiring bone graft or other open treatment
post surgical infection with development of sepsis or cellulitis requiring hospital-level treatment

Those are 4 that come right to mind. I think it's challenging because Ortho doesn't usually manage problems over the long term, but I think these are good examples that would apply to several different ortho subspecialties.
 
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