Wiki MDM risk element

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Looking for help in understanding the MDM risk statement that states "this includes the possible management options selected and those considered but not selected after shared decision making with patient/family". I am interpreting that to mean that if we were unable to perform say a minor surgery we would still be able to bill a moderate level of risk, for example, we have a patient that has pyoderma gangrenosum and sharp debridement is unable to be done due to contraindication, so we had to perform a lesser procedure which was using collagenase which is an enzymatic debridement, instead. So I can't bill collagenase for the provider per Medicare, I can bill it on the facility side, therefore I will give the provider an E/M and I'm trying to determine if I can give the moderate level E/M, or if I'm misunderstanding. Thank you so much
 
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