Wiki Oxygen in Data Points

[lynjones68]

This is a question that was posed by one of my Pulmonary Physicians. He is treating patients with COPD and they are recieving oxygen therapy. In the assignment of the risk, would this fall into moderate, as this has to have a prescrition in order to recieve it? To me it does but I actually want to see what someone else thinks.

 

[FTessaBartels]

Use "presenting Problem"

I don't consider "oxygen" a drug, even though a prescription is required to get the tank and equipment, etc.

I would use the "presenting problem" part of the table of risk, as COPD is a chronic illness. It is typically progressive in nature, though can be stabilized for a time.

Hope that helps.

F Tessa Bartels, CPC, CEMC

 

[colorectal surgeon]

I would disagree with Tessa. I think this says that their COPD is severe. One of my anesthesia colleagues has told me that anyone on home oxygen would be an ASA class IV patient, which is a pretty sick patient.

I would agree with moderate. And If I was using the table of risk, I would classify someone on home oxygen as increased risk when I'm determining risk for surgery.

Thoughts anyone?

 

[FTessaBartels]

The PHYSICIAN must document

I completely agree, colorectal surgeon, that COPD would be a co-morbidity for surgery (as would DM or a host of other chronic or acute conditions). HOWEVER ... this post isn't about assigning risk for surgery. It's about assigning risk for a medical E/M visit.

More importantly ... I am not a physician, and I cannot assume that a patient's condition is worsening or unstable. The physician must document this. Even if doctor states that a patient's POX is 90, I cannot interpret that to mean the patient's COPD is worsening or exacerbated.

This is a chief reason why MDM is so hard to code. Physicians are not always very good at documenting their thought processes. THEY know what the lab numbers mean; other physicians who may read the specialist's note will know what these numbers mean. But the coder can only code what the physician has documented. So, please, physicians - give me details. Give me differential diagnoses. Give your professional medical opinion on the severity of a patient's condition(s). Help me to help you.

F Tessa Bartels, CPC, CEMC

 

[MnTwins29]

Another thought...

Has the COPD been deteriorating or exacerbating in order to warrant the oxygen therapy? If it is documented as such for the medical necessity of this treatment, then the Rx drug management is a moot point since the COPD would be worsening.

Now, if the patient is presenting for the second, third, whatever time with the COPD and on this therapy, why is it still needed? COPD still deteriorating? A change in amounts of O2 needed because of effectiveness, side effects or other reactions? Moderate risk may still be applicable here without the use of Rx management. For medical necessity criteria, this type of documentation may be needed anyway.

Just my thoughts...