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level of risk - definitive care

  1. #1
    Location
    Wilmington, Delaware
    Posts
    12
    Default level of risk - definitive care
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    I am in need of opinions to help settle a dispute, please.

    Going solely on the basis of diagnosis...what level of risk would you give to a closed fracture of 3 metatarsals that were splinted in the ED and referred to orthopaedics for definitive care?

    Thanks in advance!!!!

  2. Default
    Hi,

    My opinion on this is we go with level-3 for risk of fracture... & for splinting & refer to ortho... I dont think they dont have much work up in er for this senario...
    Joseph Amalraj Antonisamy CPC-H

  3. #3
    Location
    Milwaukee WI
    Posts
    4,466
    Default Based on limited info
    Based on the limited info you provided ... LOW risk (acute, uncomplicated injury)

    F Tessa Bartels, CPC, CEMC

  4. #4
    Default
    Based on dx only I agree with Tessa.

    Why only on dx? The dx points should be 4 and I would think they would have gotten a Rx pain med which would be moderate.

    Just my thoughts,

    Laura, CPC

  5. #5
    Default it depends
    Well it all depends
    MDM is determined by 3 categories

    Presenting Problem=Low (acute, uncomplicate illness)
    Diagnostic test,etc.= xray (straightforward)
    Mananagement Options= rx managment (prescription pain meds, which I am confident they gave)=moderate or ***OTC medicine, like motrin is Low

    The highest overall level determine the risk, so if Rx was given the risk is moderate. I don't have the CMS guidelines in front of me, so you may want to check to seen where the splint and xray falls in the risk category.

    Melissa Freeman, RHIT,CCS-P,CPC

  6. #6
    Location
    Wilmington, Delaware
    Posts
    12
    Default
    I realize there are 3 components to MDM, of which you need only 2. My question, basically, is where in the table of risk, do you consider a closed fracture? A "simple sprain" is considered low risk; a breast lump is moderate; a PE is high..... What level is a closed fracture?

  7. #7
    Default table of risk
    According to the table of risk, it says closed treatment of fracture or dislocation, without manipulation is listed under moderate risk.

  8. #8
    Location
    Wilmington, Delaware
    Posts
    12
    Default
    thanks, Anna!!!

  9. #9
    Location
    Milwaukee WI
    Posts
    4,466
    Default Agree with Anna ...BUT
    I agree with Anna that closed treatment of a fracture is moderate risk, but the original question didn't mention that the fracture was treated. The original question only asks where to assign risk for the diagnosis of the closed fracture.

    Frequently in the ER the fracture is NOT treated ... patient is perhaps splinted and then referred to an ortho specialist for treatment.

    So if there's no treatment, the diagnosis of closed fracture would be LOW risk (acute, uncomplicated injury)

    Hope that helps,

    F Tessa Bartels, CPC, CEMC

  10. #10
    Default level of risk
    Quote Originally Posted by FTessaBartels View Post
    I agree with Anna that closed treatment of a fracture is moderate risk, but the original question didn't mention that the fracture was treated. The original question only asks where to assign risk for the diagnosis of the closed fracture.

    Frequently in the ER the fracture is NOT treated ... patient is perhaps splinted and then referred to an ortho specialist for treatment.

    So if there's no treatment, the diagnosis of closed fracture would be LOW risk (acute, uncomplicated injury)

    Hope that helps,

    F Tessa Bartels, CPC, CEMC

    Just a question then, you don't consider splinting with referral to ortho a treatment? I understand it's not fracture care, but they did treat. So, is the wording only for fracture care? I'm not trying to be argumentative, I'm trying to understand the reasoning.

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