Wiki MDM please clarify!!

[cadillacmtn]

It's very difficult to find supporting examples of correctly counting the number of diagnoses and managment options out there! For example, intractable sx for dying pts:

Scenario #1:
Hospice inpatient has worsening debility/weakness (dx stated as pancreatic ca w/ mets), and symptoms controlled EXCEPT for nausea. So, to count this part of MDM, can you count debility (next step is transitioning to dying) as est problem worsening = 2pts, and the nausea as new prob, no add wkup (prescription ordered for sx control) = 3 pts, get an extensive?

Scenario #2:
Hospice inpatient has ca dx and visit note states that patient is actively dying.
Can you count actively dying (under debility/weakness) as estab. problem, worsening = 2, agitation, improving, as est prob, improving = 1, seizures overnight as new probl, no add'l wkup (prescription ordered) = 3, and also get an extensive for this component?

THANK YOU for any advice.

 

[FTessaBartels]

I look at the entire note

To give you an accurate assessment of MDM I would need to look at the entire note, because not all physicians are good about neatly summarizing their through processes just in the A&P section of their documentation.

In general, any new problem will be worth at minimum 3 points (4 points if additional work-up is planned).

However ... you state that these patients are HOSPICE INPATIENT. Is the physician the supervising physician for hospice?

Our Pediatric Surgery practice does not deal with this scenario, but I believe that if you are NOT the supervising physician you can only treat the new problem/symptom (seizures in this case). So that is all that you would count in your MDM.

Maybe someone else has more insight. I hope that helps.

F Tessa Bartels, CPC, CEMC

 

[cadillacmtn]

more details

this is a free-standing inpatient hospice facility....... the physicians are employed by hospice, and Medicare pays outside of the hospice per diem for necessary physician visits, ie symptom management (this is not a round)............ the physician may or may not the be attending in this case