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Oncology MDM

  1. #1
    Default Oncology MDM
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    Our group just recently took on our first Oncologist. I do quarterly documentation reviews for all physicians within our group, and just met with the Oncologist to go over his documentation. Can someone please help me, and the physician, understand Oncology in the Medical Complexity world when reviewing documentation in the Medical Decision Making part?

    Obviously Oncology is a very unique and serious specialty, but when determining the complexity of the problem, how is it NOT going to be high complexity? The physician states that a lot of his patients are going to be high complexity because they have a serious illness that may pose threat to the patient's life. I don't disagree with that, but there are a lot of illnesses out there that may pose threat to the patient's life. I try to educate my physicians by saying, "What was the status of the patient on this particular encounter? If this patient was not in the current deteriation state, then I would probably not code based on a high complexity."

    Can someone please guide the Oncologist and myself in the right direction when determining the Medical Decision Making for this specialty.

    I would apprepriate any direction!!
    Tiffany Fischer, CPC, CEMC

  2. #2
    Nashville AAPC Chapter
    I can empathise with your situation. I code for five Oncology clinics here in Colorado and it is the same argument I am having here understanding what the oncologists do.

    When assigning risk, for the MDM portion I approached it this way with the physician.

    For the encounter they are seeing the patient for on that given day:
    What is the risk to the patient between now and the next visit -
    is the patient at imminent risk of death if the physician does not give them treatment at that encounter (think 1st encounter for a pulmonary embolism, severe thrombocytopenia = High Risk) - are you considering putting them in the hospital at that moment?

    Most patient's are eventually going to die of their disease is not treated, but not immenently. So we need to focus on the workup to drive the level.

    Moderate would be an established patient with a complaint of constipation.
    They probably won't die if they don't get treated and the problem may or may not resolve with treatment from the physician. If the only thing done for the problem is using over-the-counter products and nothing else was done that day, a 99212 is appropriate.

    Most patient's in oncology are going to be complex, because there is a lot of work to be done to determine what treatment is going to occur. If the physician get's two points for workup, or more then the patient moves to high complexity of data on the MDM. Most oncologists are going to review records and this gives them 2 points also. Sans, this is enough MDM for a 99205 as long as the other key elements are met for a comprehensive Hx/PE.

    They spend an inordinate amount of time answering questions and going over treatment plans, so time documentation is critical. But as a coder we must consider that most of this is just part and parcel of the MDM.

    Once the treatment plan is progressing, if the patient is not having complications and is responding, a moderate or high risk is going to be harder to justify. The workup as all ready been done.

    Here is what we use to guide us for determining levels of risk:
    Ab pain - high risk
    Ear pain - Dx otitis media - low-moderate
    Embolism followup from admission - moderate
    joint point - low
    SOB - High (possible embolism w/u)
    Chest pain - High

    I hope this helps a little.

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