MDM in 2023 E/M guidelines

[SmallBird]

In the 2023 guidelines for E+M codes on inpatient, it seems that it's both easier and more difficult to justify a high complexity code. It does however seem that one can justify this on the basis of discussing a medication that requires monitoring, even if it isn't started. In my view, this would mean that discussing, say, the option of an atypical antipsychotic which requires lipid/glucose monitoring in a patient who is manic, psychotic or suicidal, would meet criteria in terms of MDM. What do others think?

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[nexus73]

Does anyone have quick reference for new e/m rules?
Link to updated 2023 wRVU values?

Curious about interpreting inpatient scenarios that would qualify for high level MDM, especially follow-ups. It seems that ONE condition with severe exacerbation, or ONE condition that poses a threat to life or bodily function may be easy to satisfy with the majority of inpatient diagnoses.

 

[SmallBird]

I think on the plus side, for initial admission to inpatient high complexity is going to be the norm. However, subsequent days gets more difficult, unless you start a complicated med on a subsequent day or they get worse. It used to be that you could get there with the number of problems like if someone also had a medical issue come up but doesn't seem possible any more.

 

[nexus73]

This is the language I found:

• 1 or more chronic illnesses with severe exacerbation, progression, or side effects of treatment; or
• 1 acute or chronic illness or injury that poses a threat to life or bodily function

There are many patients who have persistent severe exacerbation of symptoms for several days following admission, so the first bullet could be met for high level MDM potentially.

The second bullet depends on how you read it. It could be interpreted the one problem the person has, e.g., suicidal thoughts, poses a threat to life. The definition of bodily function is also important. Is sleeping a bodily function? Eating? Mentation--concentrating, memory, orientation? If someone is depressed and not eating or sleeping, the depression poses a threat to those bodily functions potentially.

You also need "Decision regarding hospitalization". Which is vague. A decision to continue hospitalization could satisfy this, and this is a daily decision.

https://www.ama-assn.org/system/files/2023-e-m-descriptors-guidelines.pdf

My assumption is this language was created with hospitalists, intensivists, cardiologists, etc in mind, and not so much for psychiatry.