Wiki MDM questions

[melissalynnfalkowski]

I work for an endocrinologist who is on some sites with peers that have told her that they bill all type 1 dm pump patients a level 5 based on a few things.
PART1
They are using the codes and counting them in their # of dx and treatment options. If you are coding Dm with hypo/hyperglycemia or any other DM dx for that matter, would it be appropriate to count these towards the # of dx and treatment options?
Z96.41
Presence of insulin pump (external) (internal)
Z79.4
Long term (current) use of insulin
Z46.81
Encounter for fitting and adjustment of insulin pump

PART2

​They are also stating that a diabetic type 1 on a pump either cgm or other with documented highs and lows would qualify for high risk based on "drug therapy requiring intensive monitoring"
Every argument my endocrinologist gave me seemed legitimate. I mean these patients can slip into comas and there is a ton of risk
I see the drug table only lists IV insulin as inclusive of this but it could be argued that a patient on a CGM/pump isn't IV but requires same monitoring?
I know the list isn't all inclusive but just wondering your thoughts?

 

[Chelle-Lynn]

In looking at the codes and conditions I believe that in regards to MDM that you would have a valid argument for a High MDM. From the number of diagnosis issue you would have 4 or more diagnosis codes which would level to high. From a table of risk perspective the presenting problem could qualify for the:

• Acute or chronic illness that pose a threat to life or bodily function

This presenting problem would be dependent on the physicians documentation and patients current condition; but from a general medical perspective patients with a CGM are generally considered critical and/or their DM poses a life threatening condition to have continual monitoring.