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Table A.1- Trailblazer Guideline

  1. #1
    Question Table A.1- Trailblazer Guideline
    Medical Coding Books
    There has been a huge discussion in our office over table A.1 of the Trailblazer guideline.

    The example is as follows:
    Patient presents with a cut to the foot. Physician stitches the wound and documents that he is prescribing antibiotics although the wound is not currently infected due to risk of infection because the pt has DM. The physician also takes the patients chronic condition of hemophilia into account when rendering MDM and documents this.

    Based on this, many in the office say they would assign 3 points for the number of diagnoses-
    1 for the open wound under 'each new or established problem for which the dx and/or treatment plan is evident with or without diagnostic confirmation' and 2 points under '2 comorbidities clearly stated and supported by information in record.'

    Others state they would only assign 2 points-
    only counting these under the '2 comorbidities clearly stated and supported by information in record.' The reason for this argument is because it is believed that the open wound is figured in with the 2 comorbidities.

    I've searched and searched for a guide to the Trailblazer guide (haha! Isn't that silly?!) and came up with nothing. Is there an E/M or Trailblazer whiz out there who can shed some light on this??

  2. #2
    Default
    Quote Originally Posted by Reece04 View Post
    There has been a huge discussion in our office over table A.1 of the Trailblazer guideline.

    The example is as follows:
    Patient presents with a cut to the foot. Physician stitches the wound and documents that he is prescribing antibiotics although the wound is not currently infected due to risk of infection because the pt has DM. The physician also takes the patients chronic condition of hemophilia into account when rendering MDM and documents this.

    Based on this, many in the office say they would assign 3 points for the number of diagnoses-
    1 for the open wound under 'each new or established problem for which the dx and/or treatment plan is evident with or without diagnostic confirmation' and 2 points under '2 comorbidities clearly stated and supported by information in record.'

    Others state they would only assign 2 points-
    only counting these under the '2 comorbidities clearly stated and supported by information in record.' The reason for this argument is because it is believed that the open wound is figured in with the 2 comorbidities.

    I've searched and searched for a guide to the Trailblazer guide (haha! Isn't that silly?!) and came up with nothing. Is there an E/M or Trailblazer whiz out there who can shed some light on this??
    1 diagnosis; no co-morbidities. He's not treating the hemophilia or DM; he's taking them into consideration - they're risk factors. (eg, counted on the table of risk). Your # of diagnoses = 1. I'd go with the # of management options, instead - you get 2 points, there: 1 for stitching, and 1 for the ABX.

    You may have already seen this, but it's pretty informative on how Trailblazer counts stuff for E/M: http://www.trailblazerhealth.com/Pub...ponentsEOV.pdf

    And this is their main page for E/M publications: http://www.trailblazerhealth.com/Pub...rch&DomainID=1


    Hope that helps!

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