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MDM please clarify!!

  1. #1
    Question MDM please clarify!!
    Medical Coding Books
    It's very difficult to find supporting examples of correctly counting the number of diagnoses and managment options out there! For example, intractable sx for dying pts:

    Scenario #1:
    Hospice inpatient has worsening debility/weakness (dx stated as pancreatic ca w/ mets), and symptoms controlled EXCEPT for nausea. So, to count this part of MDM, can you count debility (next step is transitioning to dying) as est problem worsening = 2pts, and the nausea as new prob, no add wkup (prescription ordered for sx control) = 3 pts, get an extensive?

    Scenario #2:
    Hospice inpatient has ca dx and visit note states that patient is actively dying.
    Can you count actively dying (under debility/weakness) as estab. problem, worsening = 2, agitation, improving, as est prob, improving = 1, seizures overnight as new probl, no add'l wkup (prescription ordered) = 3, and also get an extensive for this component?

    THANK YOU for any advice.

  2. #2
    Milwaukee WI
    Default I look at the entire note
    To give you an accurate assessment of MDM I would need to look at the entire note, because not all physicians are good about neatly summarizing their through processes just in the A&P section of their documentation.

    In general, any new problem will be worth at minimum 3 points (4 points if additional work-up is planned).

    However ... you state that these patients are HOSPICE INPATIENT. Is the physician the supervising physician for hospice?

    Our Pediatric Surgery practice does not deal with this scenario, but I believe that if you are NOT the supervising physician you can only treat the new problem/symptom (seizures in this case). So that is all that you would count in your MDM.

    Maybe someone else has more insight. I hope that helps.

    F Tessa Bartels, CPC, CEMC

  3. #3
    Default more details
    this is a free-standing inpatient hospice facility....... the physicians are employed by hospice, and Medicare pays outside of the hospice per diem for necessary physician visits, ie symptom management (this is not a round)............ the physician may or may not the be attending in this case

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