Risk

agibbons

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I have a question regarding the level of Risk with management options. How would we determine the difference between Minimal Risk or Low Risk when no specific management options are discussed other than the need for diagnostic testing?

Orthopedic Example: New patient fell at work and injured shoulder, in-office xray performed (and billed) shows no fracture or other abnormalities. MRA is ordered to determine the extent of injury and to confirm suspected diagnosis (unfortunately did not explain further) Follow up after testing.

Problem Addressed: Low - acute uncomplicated problem
Data: Minimal - order 1 unique test
Risk ? Minimal vs Low could make this 99202 or 99203.

Thanks!!
 

thomas7331

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I have a question regarding the level of Risk with management options. How would we determine the difference between Minimal Risk or Low Risk when no specific management options are discussed other than the need for diagnostic testing?

Orthopedic Example: New patient fell at work and injured shoulder, in-office xray performed (and billed) shows no fracture or other abnormalities. MRA is ordered to determine the extent of injury and to confirm suspected diagnosis (unfortunately did not explain further) Follow up after testing.

Problem Addressed: Low - acute uncomplicated problem
Data: Minimal - order 1 unique test
Risk ? Minimal vs Low could make this 99202 or 99203.

Thanks!!
Assigning risk is always going to involve a certain amount of judgment - the categories for risk are just guidelines and unfortunately aren't a 'one-size-fits-all' for every situation.

With respect to your example, the 1995 guidelines, in the section on diagnosis or management options, stated that "Generally, decision making with respect to a diagnosed problem is easier than that for an identified but undiagnosed problem." I think this still applies, and any time you are dealing with an uncertain diagnosis, there is an inherent risk in that alone, and especially here given that the provider feels the additional imaging is needed. So I definitely would not classify this as minimal risk, and I would be comfortable assigning 99203 here.
 
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