Dnr

malinusky

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Hello,

Regarding the management options in the MDM, if the EMR has DNR orders from previous visit is it appropriate to credit the current visit, the DNR discussion happened on a previous visit but it stays in the record/note. Where can I get additional clarification on the applicability of the DNR as a management choice as it pertains to MDM?

Thank You!
 
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DNR already exists

The expanded description in the Table of Risk (for determining MDM) states
"Decision not to resuscitate or to de-escalate care because of poor prognosis" (emphasis added by FTB)

To me, that means that the physician has to be actively involved in making the decision to employ a DNR order at THIS encounter to be given credit for High Risk based on this criterion. So if the DNR is already in existence and there's no discussion about continuing it, but is simply mentioned in the record as existing, I don't use this to assign high risk.

However, patients with an DNR in existence frequently have presenting problems that would also be rated "HIGH" in the table of risk.

Hope that helps.

F Tessa Bartels, CPC, CEMC
 
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