Wiki audit question

[camilleb]

There is a debate in my office as to what level of risk does the ordering of Pain management fall?
I feel, that if my doctor orders that the patient must go to see a Pain Mgmt doctor, then this falls under the "high" level of risk as a management option.
Thoughts?

 

[OCD_coder]

I could see where is could fall under severe exacerbation if all other treatments have failed to control the pain and maybe the patient has difficulty performing daily living activities such as eating, hygiene or even getting dressed such as putting shoes. As I audit I select a more conservative view to start with Moderate Risk as everyone's pain threshold is different. Also, Typically pain is managed by some sort of prescription pain medication. One thought to consider is the type of medication and how it is administered, because parenteral administration of a controlled substance is High Risk.

I don't think it can be classified as High for every patient just for pain management. I would enjoy hearing other auditors opinions.

 

[MarcusM]

http://emuniversity.com/HighComplexityMedicalDecision-Making.html has some good info. If your doctor is simply referring the patient to pain management, this is not necessarily your doctor's high level of management without documentation to support a high level e and m code.