Wiki 2021 Risk Level

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carriganm

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I am seriously puzzled by the new risk guidelines. As a coder, how do WE determine the risk level if it isn't specifically notated? Or, do we need to require all our providers to specifically list the risk level of the patient in the chart for each encounter in order to appropriately determine it? Specifically for minimal or low risk? There are now zero examples on the new MDM chart for those two categories. Should we still reference the 1997 examples in determining minimal or low risk? Thanks for any suggestions.
 
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Hi Carrie,

I have asked this same exact question during webinars to both of the MACs in my region (NGS for Illinois and WPS for Missouri) and I cannot get either of them to answer this. They continue to refer me to the MDM grid/table provided by the AMA which gives no examples for the minimal and low risk and both of them stated to not use the 95 and 97 guidelines when leveling the MDM of office and other outpatient visits. Personally, since they are only examples, I don't see why we cannot refer to our previous knowledge of what constitutes minimal vs low risk (even if that knowledge came from the 95/97 guidelines. After all, they note in the 2021 Guidelines that the examples listed under moderate and high risk are "examples only.")

I also have a question related to risk. If a provider documents that a "patient is intolerant to statins" and recommends that the patient "continue proper diet and exercise" under the assessment and plan, would you count this as moderate risk for prescription drug management as the patient's intolerance to statins is impacting the provider's choice of treatment or is that a stretch? Any and all replies are greatly appreciated. I ask that you please provide a rationale.

Thanks.
 
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Charity Evans said:
Hi Carrie,

I have asked this same exact question during webinars to both of the MACs in my region (NGS for Illinois and WPS for Missouri) and I cannot get either of them to answer this. They continue to refer me to the MDM grid/table provided by the AMA which gives no examples for the minimal and low risk and both of them stated to not use the 95 and 97 guidelines when leveling the MDM of office and other outpatient visits. Personally, since they are only examples, I don't see why we cannot refer to our previous knowledge of what constitutes minimal vs low risk (even if that knowledge came from the 95/97 guidelines. After all, they note in the 2021 Guidelines that the examples listed under moderate and high risk are "examples only.")

I also have a question related to risk. If a provider documents that a "patient is intolerant to statins" and recommends that the patient "continue proper diet and exercise" under the assessment and plan, would you count this as moderate risk for prescription drug management as the patient's intolerance to statins is impacting the provider's choice of treatment or is that a stretch? Any and all replies are greatly appreciated. I ask that you please provide a rationale.

Thanks.
Click to expand...
I just found an AMAAZING E/M calculator from another forum and when selecting the risk category it gives you specific examples for each risk level!! Attached it below.

As far as your question for rx management I don't think I would personally count it as management but I was browsing the forums this morning under the E/M category and some people were asking questions relative to the above. I've pasted them below in case it helps you decide.


 
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carriganm said:
I just found an AMAAZING E/M calculator from another forum and when selecting the risk category it gives you specific examples for each risk level!! Attached it below.

As far as your question for rx management I don't think I would personally count it as management but I was browsing the forums this morning under the E/M category and some people were asking questions relative to the above. I've pasted them below in case it helps you decide.


Click to expand...
Wow!!! That E/M calculator is really awesome! And thank you for posting all of those wonderful links!
 
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