Wiki High Level of Risk : MDM

[kmartinez]

Would you agree that the diagnosis below reach a High level of risk for MDM?

Impression and Plan Summary:
Abnormal finding on a mammogram.
Orders: Mammo: screening bilateral mammogram.

DIABETES MELLITUS - TYPE II- WITH RENAL COMPLICATIONS. reviewed labs and made a copy for patient

CKD STAGE 3 (GFR 30-59) advised to drink more water, recheck labs in a month
orders: basic metabolic panel, microalbumin.

Additionally, iron deficieny, overweight (bmi 25-29.9), diabetes mellitus-type II- with neurological complications, hypertension with ckd, depression, gerd, and hyperlipidemia mixed have all been reviewed and are stable.

- Due to the renal complications and CKD would you say that it is appropriate to consider this a high level of risk under the presenting problems column.

TIA
KM

 

[thomas7331]

No, I would consider the documentation above to support moderate risk. There is nothing here to suggest that any of these conditions have 'severe exacerbation' or 'pose a threat to life or bodily function'. CKD stage 3 with an order to 'drink more water' certainly does not sound like a high risk situation.

 

[kmartinez]

No, I would consider the documentation above to support moderate risk. There is nothing here to suggest that any of these conditions have 'severe exacerbation' or 'pose a threat to life or bodily function'. CKD stage 3 with an order to 'drink more water' certainly does not sound like a high risk situation.

Great! I agree. Provider billed a 99215 and being new to auditing I wanted to make sure I wasn't missing something but I also see it as a moderate level of risk and not a high level.

Thank you for your reply.
KM CPC

 

[twizzle]

High level risk

I completely agree with Thomas. For me, two things in particular came from an AAPC medical necessity workshop I attended a few years ago.

1) Is the patient's condition serious enough that the provider might lose sleep wondering if they've managed the condition appropriately?
2) Is the provider arranging to see the patient soon to see how they're doing?

This provider is managing the patient with very conservative treatment and wants follow-up labs in a month, neither of which suggest a high risk condition.

When auditing E/M these are two factors (not the only ones) I always look at closely when the provider wants a 99205/99215. They really have to justify their choice.



Hope this helps.

 

[kmartinez]

I completely agree with Thomas. For me, two things in particular came from an AAPC medical necessity workshop I attended a few years ago.

1) Is the patient's condition serious enough that the provider might lose sleep wondering if they've managed the condition appropriately?
2) Is the provider arranging to see the patient soon to see how they're doing?

This provider is managing the patient with very conservative treatment and wants follow-up labs in a month, neither of which suggest a high risk condition.

When auditing E/M these are two factors (not the only ones) I always look at closely when the provider wants a 99205/99215. They really have to justify their choice.



Hope this helps.

Great input! Thanks for sharing.

KM CPC