Wiki What does "Illness with threat to life or bodily function (MI, ARF, PE)" really mean?

[nevrolog]

What does "Illness with threat to life or bodily function (MI, ARF, PE)" really mean?

I am not a pro coder, but I code for myself in NEUROLOGY. (..and I've done well in all my audits!)

Anyway, most of my patients have loss of function that does NOT sound so "in your face" dangerous as a PE of MI, but many of which issues are indicative of dysfunction that strikes to the core of what makes us human: mentation. Thus, I believe the patient with acute encephalopathy, progressive dementia, memory loss, etc. should all be considered HIGH in the risk table (risk of diagnosis) under the Medical Decision Making "third" of E&M coding.

Opinions??

 

[MnTwins29]

I would agree with you on these types of conditions on possibly being high on the MDM level for being a risk to functions. The only caveat I would add is that the documentation should support that level. For example, you listed memory loss as one of these conditions that could be considered high risk. I would agree if the memory loss is severe and the documentation supports that the patient has trouble functioning because of this. Simply forgetting what she had for breakfast would NOT constitute high risk! But for the most part, yes, I agree, just make the documentation supports that assertion.

Just my $0.02

 

[MarcusM]

Documentation rules our lives in the medical field. CMS indicates any inferences should be clearly gleaned from the records. The RAC auditors are not trained medically so it is best to give examples of memory loss, like patient was in my hallway and forgot why she was coming to see me is different than forgetting what she had for breakfast.

 

[gailgordon314]

I agree that in the case of the OP this is a medically complex high risk patient.

The guidelines are just that, guidelines.They are not meant to be the only examples of high risk.

For example a patient with SEVERE Copd and Uncontrolled DM w/ CKD 5 is a High Risk patient. But on the table those conditions are not specifically spelled out HOWEVER in my practice we consider them High Risk of mortality therefore High Risk e/m code.

Medically complex patients need to be viewed through the lens of risk of mortality and the risk the physician is taking on by treating someone with 3 or 4 illnesses which in of themselves can cause mortality and added together makes the patient the proverbial time-bomb.

Additionally it all comes down to documentation and medical necessity of treatment as well.