Wiki Data complexity

[RABBIT2020]

I am trying to understand Moderate complexity category 1 states that 3 of the 4 combination/bullets must be met.
Then under the data to be reviewed the asterik states - Each unique test, order or document contributes to the combinatio of 2 or combination of 3 in category 1 below.

Can someone familiar with the data reviewed for 2021 explain the meaning of these.
Can 3 uniques labs ordered be qualified for moderate level?
What would be considered document?

 

[TThivierge]

Hi SR2020
I guess this moderate complexity is that you see if the patient has one or more dx code or illnesses, plus required labs or xray or injection to help treat this patient. Also add in if there is risk involved of minor or major illness getting worse. One of the illnesses could be a chronic problem or a new problem for treatment this day. But it also depend how the provider takes care of those atleast 2 dx illnesses. Three lab test can be ordered if the provider feels like it is necessary which would be one of the bullets met make it moderate complexity. Ordering test or giving meds or injection, xray be a point for each issue. All this need to be documented in the record including the reason for the visit. Is the visit follow up or new or ongoing dx? Also provider needs to add the past and social medical history while viewing the vital signs of the person and checking out the ROS, then coming up with plan of treatment or asking the pt to return for more care. Also the pt could have 1 to 2 dx codes but doc only gave one element for treating as just labs (1) or xray(1) or injection ...that be moderate complexity plus the risk involved.

I hope I helped you listing these factors for new or returning established patient.
Have a good day!
Lady T

 

[RABBIT2020]

Thank you