Question Rx and MDM for chronic worsening

wynonna

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Regarding "Number and complexity of problems addressed
"Chronic illness with exacerbation, progression, or side effects of treatment: A chronic illness that is
acutely worsening, poorly controlled, or progressing with an intent to control progression and requiring
additional supportive care or requiring attention to treatment for side effects but that does not require
consideration of hospital level of care."
Does this mean chronic illness that is poorly controlled is unstable? What are examples/synonyms of "poorly controlled" in documentation?
2 chronic but stable=moderate.
How about 1 stable and chronic not at goal? (low or moderate? )
thank you
 

b.cobuzzi

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Actually, Wynonna, any chronic illness that is not STABLE falls under this category. Either a chronic illness is stable (meaning treatment goals have been met, which means the physician has to set treatment goals like no more than 2 sinus infections a year) or the chronic illness is with exacerbation or side effects of treatment.
 

wynonna

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Thank you. This is how I interpret it too. I wanted to get a 2nd view from an experienced ENT coder before I contact our providers. Since we discuss surgery and give Rx frequently, I'm predicting with this interpretation, and many other contributors agree, that we may have more level 4's. As long as problem is chronic and not stable, and RX and/or surgery discussion with risks takes place, or extensive data review (3 or more tests, or independent review of films or imaging) , I'm seeing level 4.
Does this sound correct?
thank you kindly
 
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