Wiki Reference materials for common problem complexities /diagnosis ( MDM )

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cheryldudley8

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Good Morning ,

I work for an urgent care company therefore we see a lot of orthopedic related illnesses and injuries. I primarily code EM's and common minor procedures in the office setting. I am looking for free ( non membership ) reference materials of common orthopaedic related problems/diagnosis as it relates to what complexity they fall under ( like acute uncomplicated illness, systemic illness with high risk of morbidity, chronic stable etc ) This is column 1 of the MDM table. I didn't know if perhaps American academy or some other type of reputable organization for this specialty has published any "examples" of these? Thanks again.
 
cheryldudley8 said:
Good Morning ,

I work for an urgent care company therefore we see a lot of orthopedic related illnesses and injuries. I primarily code EM's and common minor procedures in the office setting. I am looking for free ( non membership ) reference materials of common orthopaedic related problems/diagnosis as it relates to what complexity they fall under ( like acute uncomplicated illness, systemic illness with high risk of morbidity, chronic stable etc ) This is column 1 of the MDM table. I didn't know if perhaps American academy or some other type of reputable organization for this specialty has published any "examples" of these? Thanks again.
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It's not a free reference but if you have access to current CPT, Appendix C at the back has an extensive list of clinical examples for all of the different E/M levels at different places of services which are also identified by provider specialty. It's not specific to that one element of MDM, but honestly I wouldn't recommend trying to assign complexity just based on a diagnosis. In my opinion, which I've found is shared by many auditors, MDM should always be specific to the documentation of the encounter and not to a given diagnosis. The MDM points should be assigned based on the provider's documented assessment of the severity of the patient's condition and isn't fixed to any one particular diagnosis. There will always be an element of judgment in MDM.

Hope this helps some.
 
AAOS & Karen Zupko created an ortho-related one for the 95/97 risk table, but it won't be free. I haven't seen one for 2021 office/outpatient but I'm sure they have one with ortho example too. The 2021 definitions seem pretty clear though. If you're talking mostly new injury sprain/strain, fractures, etc. in the urgent care setting. It's probably rare to have acute systemic, chronic w/ exacerbation or severe exacerbation, stable chronic, or acute or chronic posing threat to life or bodily function (unless they chose an urgent care over the ED). You would most likely see the others: Minimal, self-limited or minor, acute uncomplicated, undiagnosed new, acute complicated.
It's difficult to make a list like this that is dependable when considering all the other elements.
When you start talking about chronic musculoskeletal issues like, low back pain, fibromyalgia, RA, OA, etc. then it can get sticky.
 
That is very true. Do you have to be a member of AAOS to access the 95/97 risk ortho-related one? Thanks again, that is helpful
 
cheryldudley8 said:
That is very true. Do you have to be a member of AAOS to access the 95/97 risk ortho-related one? Thanks again, that is helpful
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Most likely. You can join the AAOS website and access some information for free, other is member only. Try creating a free account on the website. https://www.aaos.org/quality/coding-and-reimbursement/
The coding coaches on the Zupko website are really helpful too and usually accessible. https://www.karenzupko.com/resources/coding-coaches/
 
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