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Medical Decision Making - consult in the hospital

Lassal423

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When it comes to the Diagnosis/Management Options of MDM - - If a physician is being asked to consult in the hospital on a patient that his partner has been seeing (but he hasn't seen)...is this a New Problem [to the examiner], or an Established Diagnosis?

Thank you!
Lora
 

btadlock1

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When it comes to the Diagnosis/Management Options of MDM - - If a physician is being asked to consult in the hospital on a patient that his partner has been seeing (but he hasn't seen)...is this a New Problem [to the examiner], or an Established Diagnosis?

Thank you!
Lora
You answered your own question...

"New Problem [to the examiner]"

I think you may be confusing this with 'New Patient' guidelines...If the doctor assessing the problem has never seen the patient before, or if they've never dealt with a particular problem for the patient, technically, the problem is 'new' to them.

Even if another doctor has established a plan of treatment for a problem, the second doctor is assessing it for the first time: it's the first time they're learning about the history of the problem (including its duration, severity, associated symptoms, etc.), the first time they've examined the patient with the intent of assessing body functions pertaining to that particular problem, and it's the first time they are analyzing everything they've learned that day, to form a professional opinion of their own, regarding the status of the problem, and whether the course of treatment is adequate, or if it needs adjustment. (By the way, if he documented that he reviewed the other doctor's notes, past test results, or that he spoke with the other doctor about the patient's care, he should get credit under the 'Amount/Complexity of Data" portion of the MDM).

In my opinion, the point scale for the 'Number/Severity of Diagnosis/Treatment Options', is arbitrary, and difficult to use, and often produces a score that's way too low or high. Trailblazer gives a choice between that point system, and another table, that tends to produce a more appropriate score - the attached picture shows the table I'm referring to - but that's just my preference. There's a link to their audit tool, below. Hope that helps! ;)

http://www.trailblazerhealth.com/Publications/Job Aid/coding pocket reference.pdf
 

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Lassal423

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Denver
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Thank you for the detailed information!

One question though: You can only use Trailblazer's guides if they are your intermediary...correct?

Lora
 
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Confusion

Bradi,

Does Established problem or diagnosis is related to patient or does it refers to the physician ?

You answered your own question...

"New Problem [to the examiner]"

I think you may be confusing this with 'New Patient' guidelines...If the doctor assessing the problem has never seen the patient before, or if they've never dealt with a particular problem for the patient, technically, the problem is 'new' to them.

Even if another doctor has established a plan of treatment for a problem, the second doctor is assessing it for the first time: it's the first time they're learning about the history of the problem (including its duration, severity, associated symptoms, etc.), the first time they've examined the patient with the intent of assessing body functions pertaining to that particular problem, and it's the first time they are analyzing everything they've learned that day, to form a professional opinion of their own, regarding the status of the problem, and whether the course of treatment is adequate, or if it needs adjustment. (By the way, if he documented that he reviewed the other doctor's notes, past test results, or that he spoke with the other doctor about the patient's care, he should get credit under the 'Amount/Complexity of Data" portion of the MDM).

In my opinion, the point scale for the 'Number/Severity of Diagnosis/Treatment Options', is arbitrary, and difficult to use, and often produces a score that's way too low or high. Trailblazer gives a choice between that point system, and another table, that tends to produce a more appropriate score - the attached picture shows the table I'm referring to - but that's just my preference. There's a link to their audit tool, below. Hope that helps! ;)

http://www.trailblazerhealth.com/Publications/Job Aid/coding pocket reference.pdf
 
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