Wiki Does this qualify for high MDM?

[alysenb]

We are having a discussion here about oncology E/M leveling. My thought is that if the patient has a cancer diagnosis, that that should be counted as "acute or chronic conditions that poses a threat to life". Based on the AMA definition, "that poses a threat to life or bodily function in the near term without treatment". We have new AI software that is not catching this and before I say something I wanted to get everyone's opinion on this.

 

[csperoni]

Any diagnosis, even cancer, is not automatically any specific level. It depends on the status of the problem as documented at the time of the encounter.
There are patients with a cancer diagnosis, who are currently being treated, with good response, and no side effects.
Example1: breast cancer patient who had partial mastectomy 2 years ago, no evidence of disease, and now on tamoxifen for 5 years without side effects. That problem is low level.
Example2: breast cancer patient who had partial mastectomy 2 years ago, no evidence of disease, on tamoxifen with minor side effects of hot flashes. That problem is moderate.
Example3: breast cancer patient who had partial mastectomy 2 years ago, no evidence of disease, on tamoxifen that is causing severe hot flashes, night sweats, and edema. That problem is high.
While many patients with an active cancer diagnosis *might* be high level problem, if it is not an aggressive or high stage cancer, it could easily be a lower level problem.

 

[amyjph]

Agree, just because a patient has a cancer diagnosis does not mean the COPA is high even if it is in the oncology office visit realm.