Wiki 99222 or 99223 Elective major surgery without identified risks or decision for emergency major surgery?

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bailsb

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I see this as a 99222. Auditor states 99223 for decision emergency major surgery:

Pt comes in and is diagnosed with acute appendicitis. Pt has DM only. Surgeon discusses lap appy and gives pt option of non-operative management with antibiotics or lap appy. Pt chooses lap appy. Pt taken to OR and 44970 is performed. Pt discharged the next day.

Am I incorrect?
 
I agree with you on the level of service.

acute appendicitis as an "acute illness with systemic symptoms" (Moderate - problems)
no data reviewed (Straightforward - data) [unless, of course, there is something documented in the note]

based on the provider offering a non-surgical option, I lean towards it not being "emergency major surgery", BUT, I wouldn't consider it an "elective" surgery either.

even if we count it as "emergency major surgery" in the risk column, you are still not hitting a "high" level of service.

the overall level of MDM, is based on meeting 2 out of 3 elements, or the lowest common denominator.

(I would not consider the appendicitis an "acute illness that poses a threat to life or bodily function", since the provider is offering a non-surgical option)
this is a bit rambling (it's been a long day), I hope it makes sense.
 
You make total sense and are thinking just like me. I was just discussing this with another colleague of mine. Acute illness systemic symptoms, surgeon did document a CBC, CMP, and a CT (no mention that eyeballed). Both level to moderate. As you said, even if we count it as "emergency major surgery" in the risk column it still would not hit a "high" level of service. I have no idea what this auditor is thinking, other than just trying to stir the pot or make my blood boil.

I appreciate your response. :)
 
I agree with 99222. Nowhere does the surgeon document that emergency surgery is required, in fact non-surgical treatment is also offered to the patient. I would assess this as elective major surgery without (identified) risk factors - the patient elected to undergo surgery rather than antibiotic therapy.

The fact the patient has DM could theoretically increase the risk but since nothing is documented by the surgeon to this effect, the level of risk is still moderate.
 
Another vote for 99222. An acute appendicitis could be a high level problem, but not if they are considering treatment with antibiotics. For data to be extensive, you would need besides the 3 tests reviewed to also have independent interpretation of tests or discussion of management with external provider/appropriate source.
 
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