Wiki MDM- Risk Table

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LPou1003

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I was wondering if you could give me your feedback in regards to the MDM - risk table portion.

A patient comes in with an acute complaint of Otitis media and is prescribed meds.

New problem w/ no work up (3 pts)

Data to be reviewed is 0 pts.

But on the risk section - would it be counted as moderate because of the med Rx? or low because it is an acute problem and the medication is included in the treatment of the acute/ uncomplicated problem?

Thank you for your help.

Leslie Pou :confused: :rolleyes:
 
MDM Risk

You would use the Moderate because of the RX med given. The risk table section you go with the highest
 
I myself would be careful assessing the moderate MDM for otitis media. For our local MAC, there are certain conditions that no matter how high we might get on the table of risk, they will never allow a moderate selection b/c the nature of the visit did not require it. Otitis media is one of them I believe. Just because it meets the bullet points for a moderate MDM doesn't mean we should always code it as such. Remember the reason for visit, the depth of work it took to determine the diagnosis and the complexity of care for that diagnosis. Otitis media doesn't (at least in most cases) rank up there as very complex. Just my thoughts...some say the same, some say count the points and go as high as it takes you. Good luck!
 
volleyball246@hotmail.com said:
I was wondering if you could give me your feedback in regards to the MDM - risk table portion.

A patient comes in with an acute complaint of Otitis media and is prescribed meds.

New problem w/ no work up (3 pts)

Data to be reviewed is 0 pts.

But on the risk section - would it be counted as moderate because of the med Rx? or low because it is an acute problem and the medication is included in the treatment of the acute/ uncomplicated problem?

Thank you for your help.

Leslie Pou :confused: :rolleyes:
Click to expand...

I would agree that the risk is Moderate since there was an RX given, even if the problem is an acute/uncomplicated problem. There is a risk in the doctor prescribing a medication. Now, just because the the MDM is moderate does not mean that this would warrant a higher level visit. You can still have a moderate MDM and have an appropriately documented problem focused or detailed history and exam. If the exam and history are documented correctly for the presenting problem, then the level should balance out to the appropriate level code.
 
I agree with both responses. Before you finalize your MDM level with a moderate risk, you do need to verify that your local MAC doesn't have rules stating that the medical necessity for the MDM can't be higher than the code. That stands true for some MAC regions.
 
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