Wiki Decision for surgery question

[Cheezum51]

I've had someone ask me a question about who gets credit for the decision for surgery, in respect to Moderate Risk for MDM.

Here's the scenario: I'm an optometrist and see a patient for an eye exam with complaints of significant vision problems which, after examination, are due to cataracts. I discuss the pros and cons of cataract surgery with the patient and feel they are a good candidate for surgery and then refer the patient to a cataract surgeon.

Since I'm not actually doing the surgery but evaluating the patient risk factors for surgery from my examination, do I get credit for the "decision regarding major surgery without identified patient/procedure risk factors", which allows me to have a Moderate Risk level for coding? Or, is the surgeon the only provider who can get credit for that?

I would imagine a similar situation for an FP would be a patient with chronic tonsillitis and the FP refers them to a surgeon for a tonsillectomy.

I can understand a situation where the need for surgery may not be as clear cut, such as whether a knee or back injury requires surgical intervention, but feel like if the referring provider knows that surgery is the only way to treat the problem, such as cataracts or retinal detachment for a patient seen by an optometrist, that they should also get credit in the risk category for making the decision to refer for the surgery.

If anyone has any documentation on this type of scenario, that would be very helpful.

Tom Cheezum, OD, CPC, COPC

 

[mihill]

This is a great question!
Our OD's triage care that may end up as treatment or surgery for our retina MD, could be same day or within a week. Our OD bills level 4 E&M and retina bills level 4 or 5, depending on the severity, but both providers are in the same practice. Which provider gets credit for MDM or perhaps both?
Thanks for weighing in!

 

[natashalage]

Unfortunately, I don't have documentation on this topic and I am not an expert; I just wanted to post my reasoning. Since 2 MDs belong to different specialties, each of them would get the level of Risk they believe pt has. If OD, believes that the pt needs a surgery, that's the Risk, the severity of the medical condition. Period; even though he is not performing the surgery. I believe we should focus on the condition, disease process when assessing the Risk. Pt might get blind if a surgery is not performed. That's the Risk (moderate or high).

 

[mihill]

Because of the way the rules are written, I agree with you and have been coding OD level 4 and MD level 4/5. Thank you!