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Explore This IssueOctober 2008
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The level to the Coding Corner question would be moderate-complexity decision making because at least two out of three of the following components are at a moderate level:
- Complexity: One chronic problem worsening (rheumatoid arthritis) and one additional stable chronic problem (GERD) equals two points for the worsening problem and one point for the stable problem.
- Amount and/or complexity of data to be reviewed: Additional laboratory and radiologic studies ordered equals one point for reviewing and ordering laboratory and one point for the chest X-ray ordered.
- Risk of complications and/or morbidity or mortality: This would be at a moderate level for the prescription drug therapy, with moderate risk of significant side effects.
In this moderate-complexity decision making, three points are assigned for the complexity, which means it is at a multiple level, and two points are assigned for the data review, which means this is a limited level. Lastly, the level of risk is at a moderate level.
Coding is a detailed and complex task, and the rules change often. It is important that your practice’s coding staff understands what is expected each and every time they submit a claim on behalf of your practice, and the best way to do that is by making sure they understand the ever-changing language of coding. To stay current on the most recent coding changes and expectations or to brush up on the language of coding, visit www.rheumatology.org/practice.
If you have a specific coding question, e-mail your scenario to firstname.lastname@example.org, and your question may be addressed in a future issue of “From the College.”