Wiki Medical Decision Making Table (Number of DXs or Treatment options, DATA Reviewed, and Risk table) Examples for Inpatient Hospital Coding 99221-99239?

[vasilijan.nikolovski@taskforcebpo.com]

Hi, I wanted to ask if someone can provide me with some links or websites or anything really, that may have a list of common illnesses/injuries that are good examples to use for the different levels of the MDM table for Inpatient Hospital Coding (99221-99239)

For example, just like on the Risk Table there's a row that says "Moderate" and has requirements like "Two or more stable chronic illnesses", what would a 'Stable Chronic Illness' be?

Also, I would LOVE some examples for the table that's for "Number of Diagnoses or Treatment options" I'm having a particularly hard time with this table when it comes to determining what problem is an established problem, and what's a new problem, and even when I know that it's a new problem most of the time I'm still not sure if it's a new problem with an additional workup plan or not.
I'm used to figuring out these questions mostly with 'Key Words' so if there's any kind of tips like that that I can use to make my coding a bit faster it'd be great.

And for the "Data Reviewed table" I'd like to know what exactly does the "Discussion of test results with performing physician".

I'm a CPC-A coder, but I don't have a lot of experience so that's why I'm having some trouble with this.

Again, if anyone can provide me with a good long list of common illnesses/injuries that I can use for examples for the Risk table especially, I'd really appreciate it, thank you in advance.
AND/OR if you can give me a good explanation of your own, or direct me towards a good explanation of someone else about HOW I should be determining what problem is an established/new/new with additional workup etc. that would also be great.

I posted some pictures so it'll be easier.

 

[csperoni]

The AMA 2021 outpatient guidelines provides some very good definitions. Do keep in mind the MDM table, and other information in that guide is for leveling OUTPATIENT. But the definition of a chronic stable illness applies regardless.

A lot of auditors and MACs use the Marshfield clinic tool as a guide. American College of Emergency Physicians has a wonderful page explaining a lot of it. https://www.acep.org/administration...g-and-the-marshfield-clinic-scoring-tool-faq/ It actually looks like some of your screen shots might incorporate it.

Let me try to answer some of your specific questions:
Stable, chronic illness: A problem with an expected duration of at least one year or until the death of the patient. For the purpose of defining chronicity, conditions are treated as chronic whether or not stage or severity changes (eg, uncontrolled diabetes and controlled diabetes are a single chronic condition). “Stable” for the purposes of categorizing MDM is defined by the specific treatment goals for an individual patient. A patient who is not at his or her treatment goal is not stable, even if the condition has not changed and there is no short-term threat to life or function. For example, in a patient with persistently poorly controlled blood pressure for whom better control is a goal is not stable, even if the pressures are not changing and the patient is asymptomatic, the risk of morbidity without treatment is significant. Examples may include well-controlled hypertension, noninsulin- dependent diabetes, cataract, or benign prostatic hyperplasia.

Additional workup: Is the provider ordering radiology or labs? Asking for a specialist consult?

Discussion: Discussion requires an interactive exchange. The exchange must be direct and not through intermediaries (eg, clinical staff or trainees). Sending chart notes or written exchanges that are within progress notes does not qualify as an interactive exchange. The discussion does not need to be on the date of the encounter, but it is counted only once and only when it is used in the decision making of the encounter. It may be asynchronous (ie, does not need to be in person), but it must be initiated and completed within a short time period (eg, within a day or two)
Things like speaking with cardiologist regarding echo, talking to the radiologist about whether or not a cyst was complex. It is NOT simply reading notes or a report.
I hope you find the information helpful!

My personal opinion is that a list of common illness/injury does not factor each specific patient's treatment plan, co-morbidities, severity, or risk. A healthy 28 year old with an arm fracture could be a drastically different level than an 82 year old with an arm fracture who has uncontrolled diabetes and chronic kidney disease.
I really strongly recommend reading, re-reading, re-reading and reading again the AMA 2021 Outpatient E/M guide.