Embed Size (px)
Citation preview
1
1
Stephanie is LION (Linked In Open Network). http://www.linkedin.com/in/StephanieCecchini
2
2
3
•
•
•
•
•
•
4
3
5
•
•
•
•
•
•
•
•
6
4
•
•
•
•
•
•
7
•
•
•
•
•
•
•
•
•
8
5
•
•
•
•
•
•
•
•
•
9
The 3 Key Components
Time may be used if the total time is documented and more than 50% of the
encounter is spent in counseling or coordination of care
10
1. History
History of Present Illness (HPI)
Review of Systems (ROS)
Past, Family and Social History (PFS)
2. Exam
3. Medical Decision Making
Number of Diagnoses and Treatment Options
Amount and Complexity of Data
Overall Risk
6
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
11
•
•
•
•
•
•
•
•
12
7
13
HPI:
location
quality
severity
timing
context
mod factor
duration
asso. S&S
ROS:
constit
eyes
ENMT
cardio
respir
GI
GU
MS
skin
neuro
psych
endo
hemat/lymph
allerg/immuno
PFSH:
past
family
social
Type
New Out
Pt LEVEL
(x)
Est Pt LEVEL
(x)1 0 0 PF 1 2
1 1 0 EPF 2 3
4 2 1 D 3 4
4 10 3 or2+ (Est.) C 4 & 5 5
Number of Body
Areas/Systems Examined
Typ
e
New Out Pt
LEVEL (x)
Est. Out
Patient
LEVEL (x)1 PF 1 2
2-7 limited EPF 2 3
2-7 extended (4x4) D 3 4
8 (Systems only) C 4 & 5 5
••
•
•
•
•
•
••
•
•
•
•
•
•
•
•
•
•
•
14
8
- Minor =1 each (max 2)- Est. stable/improved = 1 each- Est. worsening =2 each- New problem, w/o workup =3 each (max 1)- New problem, w workup=4 each Example Type
New or Established Outpatient LEVEL
Minimal:
1 point as totaled from above
Uncomplicated, non-
infected insect bite
Straight-
forward 1 & 2Limited:
2 points as totaled from above
Controlled HTN and
tachycardia
Low
3Multiple:
3 points as totaled from above
New patient with
migraine
headaches
Moderate
4
Extensive:
4 + points as totaled from above
Patient seen today for f/u
on OA knees and 1 year
THR check. C/O knee
pain.
MRI ordered for possible
meniscus tear. R/O
symptom of
osteoarthritis
and sprain
High
5
15
One Point Each:
Clinical Labs test(s) ordered and/or reviewed
CPT® Medicine Section Test(s)- ordered and/or reviewed
CPT® Radiology Section Test(s)- ordered and/or reviewed
Discuss patient results with performing/consulting Dr.
Decision to obtain old records or add hx from other than pt
Two Points Each:
Review & sum data from old records add hx from other than pt
(2nd) interpretation of an image, tracing, specimen
TypeNew or Established Outpatient LEVEL
Minimal:
1 point as totaled from above
Straight-forward 1 & 2
Limited:
2 points as totaled from above
Low 3
Moderate:
3 points as totaled from above
Moderate 4
Extensive:
4 + points as totaled from above
High 5
9
CMS TABLE OF RISKOverall Risk between planned encounters
Any example listed from a row below for any of the three columns will equal a level of risk.1. Presenting Problem(s) 2. Diagnostic Procedure(s) Ordered 3. Management Options Selected Type
New or Established Outpatient LEVEL
• One self-limited or minor problem, eg
cold, insect bite, tinea corporis
• Laboratory tests requiring venipuncture
• Chest x-rays
• EKG/EEG
• Urinalysis
• Ultrasound, eg, echocardiography
• KOH prep
• Rest
• Gargles
• Elastic bandages
• Superficial dressings
Minimal 1 & 2
• Two or more self-limited or minor
problems
• One stable chronic illness, eg, well
controlled hypertension or non-insulin
dependent diabetes, cataract, BPH
• Acute uncomplicated illness or injury,
eg, cystitis, allergic rhinitis, simple sprain
• Physiologic tests not under stress, eg,
pulmonary function tests
• Non-cardiovascular imaging studies with
contrast, eg, barium enema
• Superficial needle biopsies
• Clinical laboratory tests
requiring arterial puncture
• Skin biopsies
• Over-the-counter drugs
• Minor surgery with no identified
risk factors
• Physical therapy
• Occupational therapy
• IV fluids without additives
Low 3
• One or more chronic illnesses with mild
exacerbation, progression, or side effects
of treatment
• Two or more stable chronic illnesses
• Undiagnosed new problem with
uncertain prognosis, eg, lump in breast
• Acute illness with systemic symptoms,
eg, pyclonephritis, pneumonitis, colitis
• Acute complicated injury, eg, head
injury with brief loss of consciousness
• Physiologic tests under stress, eg,
cardiac stress test, fetal contraction stress
test
• Diagnostic endoscopies with no
identified risk factors
• Deep needle or incisional biopsy
• Cardiovascular imaging studies with
contrast and no identified risk factors, eg
arteriogram, cardiac catheterization
• Obtain fluid from body cavity, eg, lumbar
puncture, thoracentesis, culdocentesis
• Minor surgery with identified risk
factors
• Elective major surgery (open,
percutaneous or endoscopic) with
no identified risk factors
• Prescription drug management
• Therapeutic nuclear medicine
• IV fluids with additives
• Closed treatment of fracture or
dislocation without manipulation
Moderate 4
• One or more chronic illnesses with
severe exacerbation, progression, or side
effects of treatment
• Acute or chronic illnesses or injuries that
pose a threat to life or bodily function, eg
multiple trauma, acute MI, pulmonary
embolus, severe respiratory distress,
progressive severe rheumatoid arthritis,
psychiatric illness with potential threat to
self or others, peritonitis, acute renal failure
• An abrupt change in
neurologic status, eg, seizure, TIA,
weakness, or sensory loss
• Cardiovascular imaging studies with
contrast with identified risk factors
• Cardiac electrophysiological tests
• Diagnostic Endoscopies with identified
risk factors
• Discography
• Elective major surgery (open,
percutaneous or endoscopic) with
identified risk factors
• Emergency major surgery (open,
percutaneous or endoscopic)
• Parenteral controlled substances
• Drug therapy requiring intensive
monitoring for toxicity
• Decision not to resuscitate or to
de-escalate care because of poor
prognosis
High 5
17
18
10
•
•
•
•
•
•
19
•
•
•
20
11
•
•
••
•
21
•
•
••
•
•
22
12
•
•
•
•
•
•
23
•
24
13
•
•
25
•
•
•
26
14
•
•
•
27
•
•
28
15
29
•
•
•
•
•
•
•
30
16
•
•
•
•
•
31
•
•
•
32
17
Pt
Actively
“sick” or injured?
Pt
w/ stable or inactive
Condition/s?
Pt w/ minor or self
limited problem/s?
Start:
A medically necessary, separately billable, evaluation and management service.
Dr. is treating (or Tx is impacted by all diagnoses counted)
No
No
Pt risk of life or
limb between now &
next encounter?5Yes Yes
3 or 4
No
More than 1
problem?
2 or 3
Yes
No
Yes
1 or 2
More than 1
problem?Yes
No
More than 2
problems?2 or 3
2 or 3
Yes Yes
No
Preventive
Medicine
No
More than 3
problems?4 or 5
3 or 4
Yes
No
*This chart should only be used for the purpose of guiding discussion: it references new outpatient visits
33
•
•
34
18
•
•
•
•
35
•
•
•
•
•
•
36
19
•
•
•
•
•
•
•
•
•
37
•
•
•
•
•
•
38
20
•
•
•
•
39
•
•
•
•
40
21
•
•
•
41
•
•
•
•
•
•
•
•
•
42
22
•
•
•
•
43
•
•
•
•
•
•
•
44
23
Combining ICD-10 CDI Training Sessions
•
•
45
•
46
24
47
80% of those in pre-med will not be accepted to medical school
Medical school
•
•
2008 2023
2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 2023
2008 - 2012
Under-Grad
2012 - 2015
Medical School
2019 - 2020
Fellowship
2016 - 2023
Residency
2019
License to Practice
48
25
•
•
↓
49
50
