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Moderate Medical Decision Making

  1. Default Moderate Medical Decision Making
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    Would you consider a physician giving a patient a consult to a specialist (in this case ortho) as a MODERATE Management Option on the Table of Risk? Just having a hard time deciding where a consult falls ....Thank you!

  2. #2
    Short answer: No.

    Longer answer: No, I do not see anywhere in the Risk Table (per CMS guidelines) which refers to any consultation or referrals. You might be able to swing a referral/sending a patient to a consultation, under "additional workup" in the Diagnosis and/or Management Options (C-1) of the MDM.

    Remember that a consultation is type of E/M visit, and I have not read or seen anything which would suggest a consultation request would get credit in the Risk Table. I see the "Elective major/minor sugery w/ w/o risk", however that is not the same as sending a patient to get a consultation with an Orthopedist.

    Hope that helps!
    "When you have exhausted all possibilities, remember this: You haven't!"
    -Thomas Edison

  3. Default
    Medical Billing
    That does help - thank you ! I've asked the coder who said that a consult should be a Moderate Management Option to show me where there is documentation to support that and I haven't heard anything yet. My thought is if PT and OT are under LOW, then why would a specialist consult be MODERATE? Thanks again!

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