Wiki Orthopedic Clinic E&M Level 5 for 2021

[Lisa Strickler]

I am looking for some input on what guidelines are being used for High complexity of problems addressed, in regards to orthopedics. Our providers seem to think about it differently than I do. They feel that deciding to do surgery on a rotator cuff, ACL etc is considered high complexity and I do not. Part of the problem is there doesn't seem to be good examples of orthopedic problems that are of high complexity. I would appreciate any help or ideas


Lisa S

 

[twizzle]

I am looking for some input on what guidelines are being used for High complexity of problems addressed, in regards to orthopedics. Our providers seem to think about it differently than I do. They feel that deciding to do surgery on a rotator cuff, ACL etc is considered high complexity and I do not. Part of the problem is there doesn't seem to be good examples of orthopedic problems that are of high complexity. I would appreciate any help or ideas


Lisa S

Decision to perform major surgery without risk factors is moderate (level 4), the number of diagnoses would be low - level 3 (acute uncomplicated problem, although it could possibly be moderate if it was a severe injury maybe requiring more than one surgery), and the data would probably be low for ordering/reviewing/interpreting x rays/MRI. Best you would get would be a level 4 unless they documented on time. As far as basing the code on MDM, 4 would be the very highest for those kind of problems - rotator cuff, ACL. Interested why your providers think these are high complexity.

 

[jenldavid34]

Decision to perform major surgery without risk factors is moderate (level 4), the number of diagnoses would be low - level 3 (acute uncomplicated problem, although it could possibly be moderate if it was a severe injury maybe requiring more than one surgery), and the data would probably be low for ordering/reviewing/interpreting x rays/MRI. Best you would get would be a level 4 unless they documented on time. As far as basing the code on MDM, 4 would be the very highest for those kind of problems - rotator cuff, ACL. Interested why your providers think these are high complexity.

I am running into the same problem with our providers. Our providers seem to think that as long as the DX says severe, for example severe osteoarthritis is a level 5, and they are going to do a total knee, hip, etc, and that they think it is a level 5 as well. There explanation is that it requires hospitalization in regards to DX and the procedure has identified risk factors. I don't think of it that way, but they hate the idea that all of this is extremely subjective. What do you think?

 

[jenldavid34]

I am running into the same problem with our providers. Our providers seem to think that as long as the DX says severe, for example severe osteoarthritis is a level 5, and they are going to do a total knee, hip, etc, and that they think it is a level 5 as well. There explanation is that it requires hospitalization in regards to DX and the procedure has identified risk factors. I don't think of it that way, but they hate the idea that all of this is extremely subjective. What do you think?

I think there should be a totally separate E&M audit tool for orthopedic surgeon practices, lol.