Below is the impression by our provider and my question here is , can we count below listed chronic conditions like DM2 , hTN, hyperlipidemia & hypothyroidism towards MDM elements?
# Right poorly differentiated squamous cell lung cancer with pleural met deposit; surgery believes he's not a surgical candidate. His PDL-1 expression is found to be 60% which qualifies him for keytruda (1); this showed improved response rates as well as PFS compared to first line platinum doublet chemotherapy.
I'll have him get labs today, upload recent imaging into Sutter's system, and chemo teach for keytruda. I plan to repeat image after 4 infusions. I plan to keep him on this as long as he's tolerating and as long as it's effective. Chance of response is high given his high PDL1 expression.
# DM2: hgbA1c elevated 8.4; on glyburide, metformin; f/u primary
# hypertension: controlled on lisinopril, coreg; f/u primary
# hyperlipidemia: lipid panel done 9/26/17, controlled on tricor, lipitor; f/u primary
# Hypothyroidism: on replacement; controlled; recent TSH 9/2017; f/u primary
Here is the MDM Split according to our auditors
Diagnosis – 1 point
1 point for established problem stable. Although the cancer has metastasized this was previously diagnosed, therefore it is not a new problem nor is it worsening “today”. “He’s doing well and stable since last visit; he states feeling well.”
You cannot count the chronic conditions since he is not managing them but you would code them for HCC/RAF
Data – 2 points
1 point labs
1 point decision to request outside imaging records
No points for CT scans since these are populated on all previous visits and are not new results
Risk – High Keytruda - Drug therapy requiring intensive monitoring for toxicity.
MDM = Low
Supports 99213. Provider billed 99215.
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I think it is reasonable that the provider had to consider these additional chronic illnesses during his/her medical decision-making. I give credit for them, even when not being treated, if the provider explains how the untreated conditions affected his/her MDM.