Do you count co-existing conditions, that are not treated, but are listed in the dx list?
Pt sees a general surgeon for hemorrhoids, exam is problem focused...but surgeon lists all this guys co-existing problems in his assessment list. Do you count these in the "amount of diagnoses" box, or in the table of risk?
What if they are related or not related....like this guy has asthma, diabetes, depression, sleep apnea, and Hx of Colon cancer.
Can you take this into consideration for say a minor surgery with risk...or does the doctor have to state specifically that because of his chronic illnesses there is more risk with surgery?
Thanks
Pt sees a general surgeon for hemorrhoids, exam is problem focused...but surgeon lists all this guys co-existing problems in his assessment list. Do you count these in the "amount of diagnoses" box, or in the table of risk?
What if they are related or not related....like this guy has asthma, diabetes, depression, sleep apnea, and Hx of Colon cancer.
Can you take this into consideration for say a minor surgery with risk...or does the doctor have to state specifically that because of his chronic illnesses there is more risk with surgery?
Thanks