Wiki Why is this a level 4 visit?

Create Wiki
Hi B
Moderate level visit is due to amount of new dx. or ongoing chronic dx codes, any ancillary visits given (lab /xray) and if prescribe medications during treatment.
Hope this data helps you.
Lady T
 
Clinical Vignette #5- I question the fact they are saying this is an acute illness with systemic symptoms. The patient is a 3 y/o with right ear pain, mild rhinorrhea, and not sleeping well due to pain. Temp at home is 101.3F. Temp in the clinic is 100.4F. Does everyone agree this is an acute illness with systemic symptoms? Differentiating an acute, uncomplicated illness from an acute illness with systemic symptoms is the achilles' heel for providers and coders. Would love to have your feedback!
 
blaymon said:
Clinical Vignette #5- I question the fact they are saying this is an acute illness with systemic symptoms. The patient is a 3 y/o with right ear pain, mild rhinorrhea, and not sleeping well due to pain. Temp at home is 101.3F. Temp in the clinic is 100.4F. Does everyone agree this is an acute illness with systemic symptoms? Differentiating an acute, uncomplicated illness from an acute illness with systemic symptoms is the achilles' heel for providers and coders. Would love to have your feedback!
Click to expand...
Hi Auditor here I would love feedback as well, that is the same one I questioned more like a symptom. Was wondering if they counted the decreased appetite as systemic.
 
blaymon said:
Clinical Vignette #5- I question the fact they are saying this is an acute illness with systemic symptoms. The patient is a 3 y/o with right ear pain, mild rhinorrhea, and not sleeping well due to pain. Temp at home is 101.3F. Temp in the clinic is 100.4F. Does everyone agree this is an acute illness with systemic symptoms? Differentiating an acute, uncomplicated illness from an acute illness with systemic symptoms is the achilles' heel for providers and coders. Would love to have your feedback!
Click to expand...
Maybe the not sleeping well to count as systemic symptoms? To me, if it's not "uncomplicated", then I usually consider it a moderate problem. There is no "acute complicated illness" category, but there should be. I consider "acute complicated illness" to fall between "acute complicated injury" and "acute illness with systemic symptoms", which are both moderate risk. I use the AMA guidelines as just that - guidelines. They cannot give every clinical scenario. IMHO, some E&M leveling is black and white. But many are shades of grey. How light or dark the grey is can definitely be open to interpretation. I teach my coders that if they are using a particular level, they should be able to defend it in an audit. Even if I might disagree and would have personally coded it differently, if they can logically defend the level, and I see where they are coming from, in an internal unofficial audit, I would not count them wrong. I often try to take the whole case into account.
The AMA guideline states under the problem heading: "The final diagnosis for a condition does not, in and of itself, determine the complexity or risk, as extensive evaluation may be required to reach the conclusion the the signs or symptoms do not represent a highly morbid condition. Therefore, presenting symptoms that are likely to represent a highly morbid condition may "drive" MDM even when the ultimate diagnosis is not highly morbid. The evaluation and/or treatment should be consistent with the likely nature of the condition. Multiple problems of a lower severity may, in the aggregate, create higher risk due to interaction." In this context, risk means the condition risk and NOT the treatment risk, which is a separate element of MDM.
This one statement alone makes almost every problem leveling some shade of grey.
 
You must log in or register to reply here.
Top