Wiki Mdm

[nyyankees]

If a dr refers their patient to a general surgeon what level of risk would you give that? Does the fact that it's a surgeon allow a Moderate risk level?

 

[nyyankees]

It depends on the amount of work/counseling the doctors spent with the patient. Depending on the severity of the dx and care, I would code a LOS 3 or 4.

The patient has a lump on his back and that's why she refered him to a general surgeon. Could that give me a Risk level of moderate in my MDM calculations? That's what I am not 100% sure of. Thanks.

 

[nyyankees]

If the referring doctor did not order/review labs, x-rays, and did a brief exam, I would give it a LOS 3.

It's not the LOS I am asking about. My question is in the MDM does the decision making of sending a patient to a surgeon support a Moderate Risk in the Risk porion of the MDM. I am not billing the refered doc (general surgeon) but for the doc that is sending the patient to the surgeon. Thanks again.

 

[MnTwins29]

I would assign moderate risk level based on the nature of the presenting problem. "Lump in the back" certainly qualifies as an undiagnosed new problem.

 

[nyyankees]

I would assign moderate risk level based on the nature of the presenting problem. "Lump in the back" certainly qualifies as an undiagnosed new problem.

good point..

 

[MikeEnos]

Yeah, I would go more based on the nature of the presenting problem in this case. Just the mere fact that they are sent to a surgeon does not necessarily mean the overall risk is moderate.

It stands to reason that if the provider is selecting that management option, the patient probably does have either a new problem with uncertain prognosis, or a chronic problem with mild progression. Those situations DO qualify as moderate risk.

 

[nyyankees]

Yeah, I would go more based on the nature of the presenting problem in this case. Just the mere fact that they are sent to a surgeon does not necessarily mean the overall risk is moderate.

It stands to reason that if the provider is selecting that management option, the patient probably does have either a new problem with uncertain prognosis, or a chronic problem with mild progression. Those situations DO qualify as moderate risk.

thanks.