Creative Medicines Management

High Complexity Medical Decisions

What elements of medical decision making qualify as "high complexity?" (For more information, see "Tips for medical documentation and coding.")

Two out of three are required (a large number of diagnoses, complex data to be reviewed, and/or high level of risk):

1. A large number of diagnoses or management options, either:

A new problem with additional investigations
Two established problems that are worse or uncontrolled
One established problem that is worse or uncontrolled and two stable problems
Four stable problems

2. A large amount and/or high complexity of data to be reviewed, including five of the following:

Review of lab test reults
Review of the reports of radiology studies
Planning to order new tests
Directly visualizing and interpreting a test (an ECG, for example)
Deciding to obtain old records or additional history from other sources
Summarizing the relevant findings from other sources
Discussing test results with the performing/interpreting physician

3. A high risk of complications, morbidity, or mortality related to either:

The problem
Chronic with severe exacerbation
Acute or chronic which threatens life or limb (severe kidney disease, for example)
Abrupt change in neurologic status
The diagnostic procedure
Cardiovascular imaging with contrast and risk factors
Diagnostic endoscopy with risk factors
The management
IV narcotics
Drug therapy requiring monitoring for toxicity
The decision to make a patient "not for resuscitation" or withdraw care because of poor prognosis
Elective major surgery with risk factors
Emergency major surgery

posted by John Blenkinsopp @ Friday, October 07, 2005