Thank you for your response.
Based on your guideance above, you are ignoring the addition to the guidelines. The guidelines state:
"Patient OR procedure risk factors"
I am an auditor of +15 years with specialty e/m auditor certification. I feel if you only count those that are related to the patient then you are only following the new guidelines partially.
If that's what you feel, then that's what you should do. Different auditors will always interpret guidelines differently and I've always said that if you can explain why you made your choices, as you've just done, then you're doing your job correctly.
But to explain where I'm coming from, the old 1995 guidelines stated that "
Because the determination of risk is complex and not readily quantifiable, the table includes common clinical examples rather than absolute measures of risk." I feel that this guidance should still apply and based on this, my position is that inherent risks such as those that are listed in every surgical and/or anesthesia consent form are generic and usually list many of the very rare complications which are unlikely to occur but are required by law to be disclosed. These are risks that are present in every procedure or treatment and are not specific to the MDM as pertains to a specific encounter, so shouldn't be treated as an 'absolute measure of risk'.
One of the reasons for the revision of the guidelines is to simplify document and get away from the templated histories and exams that support levels but contribute little clinically meaningful information to the record. The same could be said in this case - if providers template the generic risks of every procedure into their notes, there would be no meaningful distinction between a procedure with identified risks and one without, and providers, coders and auditors would always choose the higher level, and we'd just be back where to where we started.
To be truthful, I think there are many questionable things in these new guidelines that making auditing E&M levels almost a meaningless exercise. Selecting a level of risk for MDM was always a very subjective thing, and now that has become almost a determining factor in the outcome of the E&M level itself. I feel that the guidelines were well intended and may have made sense on paper but were likely not tested thoroughly in practice before publication. In practice, these guidelines may have made documentation simpler, but they've made coding and auditing more grey than it already was. I'm hoping that some clarifications will be published that will help correct this, but until such time, we just have to do the best we can.
Sorry to editorialize here, and I know some of my frustrations with this system may be showing through, but hope this might help some.