Dnr

A provider told me that he could increase his level of service by documenting DNR on is inpatient stays. I realize DNR is listed on the high level MDM but I would like clarification. I would think listing DNR is appropriate if indeed the patient states his wishes but in determining the medical decision making I would not be basing my level of medical decision making on DNR unless indeed the patient's status is in a state of demise and taking into account other medical factors. Is this correct?


Thank you,
Medcoder

Dnr

Medical decision making refers to the complexity of establishing a diagnosis and/or selecting a management option as measured by:
• the number of possible diagnoses and/or the number of management options that must be considered;
• the amount and/or complexity of medical records, diagnostic tests, and/or other
information that must be obtained, reviewed and analyzed; and
• the risk of significant complications, morbidity and/or mortality, as well as
comorbidities, associated with the patient's presenting problem(s), the diagnostic
procedure(s) and/or the possible management options

All factors must be considered in determining the level of MDM, not just one element.

DNR decision is high risk on risk tables

so you can get a high level Medical Decision Making (if you are talking DNR the patient likely has high level problem points) and if you meet the other levels, you can get a high level visit

Dnr

But, just because the patient is DNR status does not automatically make them high risk on the table of risk. It's not the sticker on the chart that says DNR, it's the condition of the patient when being seen at that particular encounter.

For example, a patient could be DNR, doesn't want to be intubated, etc., but comes in with a bronchitis. The patient wants and accepts antibiotics. That would be moderate MDM.

My error

It is the decision to make a patient DNR (or even the documented discussion that DNR was discussed and Full Code chosen) that makes it High Risk. The next day you start from scratch and can't count DNR again (unless the patient changes their mind and you re-address the issue)