As far as I am aware, Trailblazer is the only one that has revised the MDM process. Here is a link to their audit form.
http://www.trailblazerhealth.com/Publications/Job Aid/coding pocket reference.pdf
First Column - meaning problems column (Number of diagnoses or management options)?
Self-limited or minor (maximum of 2)
Established problem, stable or improving
Established problem, worsening
New problem, with no additional work-up planned (maximum of 1)
New problem, with additional work-up planned
If it is this column, for the most part would it not fall into one of these for a patient presenting to the ER?
New problem, (to provider) with no additional work-up planned (maximum of 1)
New problem, (to provider) with additional work-up planned
How does all of this affect ER coding?
Thanks for sharing.
There are 3 parts to MDM, accoring to Trailblazer:
You've got your # of diagnosis/treatment options, Amount/complexity of data reviewed, and risk. The first 2 have values from 1-4 points (corresponding with Straightforward MDM - High), and the third utilizes the Table of Risk, which is sort of a composite grouping of the risks associated with the problem itself, the diagnostic procedures relating to the problem, and the chosen treatment option(s) - the risk is determined to be the highest level of risk in any given column of the table of risk.
To be completely honest with you, I find Trailblazer's MDM point-system kind of confusing, especially when it comes to the # of diagnoses/treatment options. You have a point tally for the # of diagnoses, and a separate one for the # of treatment options, and you're supposed to use the higher total # of points between the two. I almost always end up using the 'treatment' points, because I'm not sure if I'm allowing the right # of 'diagnosis' points.(See pages 2 & 3 or the audit tool:
http://www.e-medtools.com/Aqua_Medicare_Coding_Worksheet.html)
For example, I'm not sure how many points to give for a patient with 2 distinct complaints, when the diagnosis hasn't been established for one, and the provider is trying to confirm/rule-out 2 or more specific differential diagnoses - and the other complaint is for an established problem with confirmed co-morbidities - it seems like nearly anytime the patient has more than one problem, you could easily go over 4 points. On the flip side of that, as you pointed out - the patient may only have one problem which could be pretty severem which would be hard to score accurately using the points available - I could know that a problem is serious, and it's obvious to me that the diagnostic tests are geared toward determining a specific suspected diagnosis, but unless the doctor lists every possible condition they're theorizing every time, I have absolutely no idea how mnay plausible differential diagnoses there may be for a given set of symptoms - I'm not a doctor. It's much easier to identify the number of treatment options, so I'm more comfortable using that point total. My experience has been that doctors document their management plans within a much closer ratio to the actual severity of the problem, (i.e., 1 point for a minor problem, 2-3 for typical moderate problems, 4 points for a really serious problem).
The question LTibbets was asking, is in regard to the
table of risk, in particular. She had heard that instead of selecting the highest level of risk reached as the overall risk level (across all 3 columns), that auditors would mainly focus on the first column, which only pertains to the risk associated with the problem, and they'd give less consideration to the risk levels in the other 2 fields, which I don't think is right - I think the explanation the consultant gave her was misleading, and probably didn't communicate what they were trying to say, in the way they thought it had.
So, before I ramble on too much further - does that clear things up any?