Medical Decision Making Macular Degeneration

With macular degeneration, something that everyone sees in their office and will this be low, will this be high, level four, level five? It’s similar to the closed-angle glaucoma, you can make a case, depending on the history and the review of systems, history of present illness, chief complaint, and that patient might be a level four or might be a level five. It could easily be one or more chronic illness with progression that’s uncontrolled or it could be an undiagnosed new problem with an uncertain prognosis, so easily be moderate. If the patients got a vitreal hemorrhage and with retinal detachment and the threat to loss of sight is high, maybe we’re meeting level five on the number and complexity of problems. If we take a look at the data complexity we’re probably going to be in the moderate range. Probably going to have some discussion of management of test interpretation which is immediately going to take us to a level four. We may have some of these other tests to review or unique tests that we ordered, but most of the time we’re probably going to be at a level four there. High risk of morbidity of additional testing or treatment or moderate risk, most of the time i think we’re going to be, I’m probably going to be in the moderate risk of morbidity from additional diagnostic testing and treatment. If I was the vitreal retinal surgeon at doing injections or especially with respect to vitrectomy and retinal repair, I’m going to probably be a level five as I believe I can meet a number of the components in level five. So, thank you Maritza and something we haven’t really addressed much in this presentation so far is we kept everything down to one problem addressed, but certainly under number of complexity of problems, now we’re into, maybe we’re into one, two, three or more illnesses that we’re dealing with. So, it might be hypertension, it might be glaucoma, it might be macular degeneration, it might be all three or it might be glaucoma diabetes. It could be many combinations of any of those. And so now, we’re moving into different levels of coding, just based on number of problems addressed and the key being, addressing the problem in your assessment and treatment plan. And then how is your involvement in treatment expected to impact the outcome of the disease and when will you be reevaluating that. And so, documentation on that particular approach is really, really important. So, thanks again Maritza for allowing us a few minutes to talk about that.



Thank you Dr. Cockrell. I think you make an excellent point on that as all of our examples have only included one problem addressed, but that might not be the case when they present themselves in your office. So, thank you for that.