Wiki MDM level for acute fracture

[pJohnson15]

When an elderly patient has multiple co-morbid conditions like Alzheimer's disease, severe COPD, end-stage heart failure, etc. and sustains an acute fracture that is found not to be a surgical candidate, would the fracture be an acute, complicated injury or an acute injury that poses a threat to life or bodily function? Thanks in advance.

 

[jkyles]

Hi there, could you provide a bit more detail? Were the other conditions a factor in the provider's decision-making?

 

[pJohnson15]

This would be for a Hospice patient receiving PO pain medications, with 2-3 imaging studies reviewed.

 

[amyjph]

It would be difficult to say without a full note/information. It always goes back to the definitions and documentation. https://www.ama-assn.org/system/files/2019-06/cpt-office-prolonged-svs-code-changes.pdf

1. "Acute, complicated injury: An injury which requires treatment that includes evaluation of body systems that are not directly part of the injured organ, the injury is extensive, or the treatment options are multiple and/or associated with risk of morbidity. An example may be a head injury with brief loss of consciousness."

2. "Acute or chronic illness or injury that poses a threat to life or bodily function: An acute illness with systemic symptoms, an acute complicated injury, or a chronic illness or injury with exacerbation and/or progression or side effects of treatment, that poses a threat to life or bodily function in the near term without treatment. Examples may include acute myocardial infarction, pulmonary embolus, severe respiratory distress, progressive severe rheumatoid arthritis, psychiatric illness with potential threat to self or others, peritonitis, acute renal failure, or an abrupt change in neurologic status."

It depends on where/what the fracture was. Was it an open fracture with contamination and risk of compartment syndrome? Did they fall and get a proximal femoral fracture? Was it a toe fracture? Was it a wrist fracture? etc. Did they cast it, brace, give a boot or some other non-op treatment because of the co-morbid conditions of the patient? The fracture itself may not pose a threat to life or function, it's the fact that they have the other problems and can't have surgery. It seems you may be mixing the "number and complexity of problems addressed" with the risk element. It's most likely moderate or low as far as the # and complexity of problems addressed. However, the risk of complications and/or morbidity or mortality of patient management could be high in your example. Then you would have to take into account the data element.

 

[jkyles]

This would be for a Hospice patient receiving PO pain medications, with 2-3 imaging studies reviewed.

So it sounds like the provider didn't look at the other conditions. Is that correct?

If relevant to the visit the review of imaging studies would count toward data, not the complexity of problem addressed, medications toward risk.