Wiki Mdm - psych potential threat to others

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JCROYLE

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I have an IP psych record. The physician is stating the patient is having homicidal ideations, but he believes that his Axis 1 (psych dx) has nothing to do with the fact that the patient wants to kill this person. He believes that this would likely be better handled in the legal system, rather than the psychiatric mental health system.

My question is, would this fall into the high MDM bucket for complexity? My table of risk states, "psychiatric illness with potential threat to self or others" as a high complexity, and since the physician is stating it's not related to a psychiatric illness, I'm a little unsure on how to score this, whether it's a moderate or high complexity. The physician is adjusting medications, so it would qualify as a moderate complexity with the rx management.

Thoughts?
 
I would give this high risk. The patient's instability qualifies this as high risk, at the very least, but your MDM also has to include # of diagnoses and management options and data. I wouldn't assign high MDM just on the risk. One other element of MDM also has to be high, or you'll have to drop down to a lower MDM.
 
For the psych diagnosis that is documented, what is the severity of it? Stable, improving, deteriorating? Is it something new or established? That would also affect the MDM as well as the number of dx.

Agree with Pam on the risk - even if not directly related, if the physician documents the risk to the patient or others, I would make the risk portion of MDM high.
 
I have 4 + dx, and the patient is having the recurring thoughts of seriously harming this other individual whom is not on the unit. The problem has now become established since his IP stay and the pt actually has a plan of intent to harm. I'm leaning towards high risk/complexity for the MDM. Even though the physician is stating this is not a psych related dx, I feel this patient needs to be monitored closely for the danger to self or others.

Agree or disagree?
 
Is the provider addressing all four diags...or are they listed incidentally? The presenting problem(s) that are being addresses should drive the diagnosis/management options, not the list, if those diags are informational only.
 
We have psychosis, antisocial personality disorder, history of brain tumor with epilepsy, history of abuse as child, HTN, hyperlipidemia, and COPD.

He is addressing the first 3, but the patient is on medication for the HTN, so that is being addressed as well, with the physician's interpretation of interatction of meds
 
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