Rita B. Conley
Guest
I have an interesting question that I would like clarification/opinions on. In table C of the audit tool (Risk of Complications/Morbidity/Mortality), under the "Mgmt Options" column and then under the "High" level, the "Decision not to resuscitate or de-escalation of of care because of poor prognosis," needs further clarification.
What level of medical necessity would you think is appropriate if during an out-patient office visit a patient is simply stating as part of his/her advanced directives that he/she would not want to be resuscitated, etc., so a DNR/DNI order is written and signed by the PCP. In this situation, and depending on how many presenting problems the patient has, I could see a low to moderate level in table C.
On the other hand
, if the patient were extremely ill and at the end of his/her life and the decision to de-escalate care, etc., is made, I could understand checking off a high level under management options.
There is a ton of stuff out there surrounding DNRs, etc., but nothing I could specifically find related to coding and level of medical necessity supported.
Can I get anyone's thoughts and/or opinions??
What level of medical necessity would you think is appropriate if during an out-patient office visit a patient is simply stating as part of his/her advanced directives that he/she would not want to be resuscitated, etc., so a DNR/DNI order is written and signed by the PCP. In this situation, and depending on how many presenting problems the patient has, I could see a low to moderate level in table C.
On the other hand
, if the patient were extremely ill and at the end of his/her life and the decision to de-escalate care, etc., is made, I could understand checking off a high level under management options. There is a ton of stuff out there surrounding DNRs, etc., but nothing I could specifically find related to coding and level of medical necessity supported.
Can I get anyone's thoughts and/or opinions??
