E/M leveling can be a challenge, especially when it comes to problems addressed. It is critical to reference and read the definitions associated with each problem in this category.
In this case, high risk category problems and their definitions are listed.
Acute or chronic illness or injury that poses a threat to life or bodily function: An acute illness with systemic symptoms, an acute complicated injury, or a chronic illness or injury with exacerbation and/or progression or side effects of treatment, that poses a threat to life or bodily function in the near term without treatment.
Chronic illness with severe exacerbation, progression or side effects of treatment: The severe exacerbation or progression of a chronic illness or severe side effects of treatment that have significant risk of morbidity and may require hospital level of care.
Common scenarios in the ED might include: pulmonary embolism, respiratory failure, AMI, small bowel obstruction, GI bleed, severe sepsis, acute renal failure, threat or attempt to harm oneself or others, CVAs, TIAs.
I can definitely see severe exacerbation of heart failure, diabetes and cancer (all chronic illnesses), requiring hospitalization falling into this category.
These are pretty obvious scenarios. However, it is important to remember that in the guidelines it states, "the final Dx for a condition does not, in and of itself, determine the complexity or risk, as extensive evaluation may be required to reach the conclusion that the signs or symptoms do not represent a highly morbid condition." However, it is also imperative to understand is that "the evaluation and/or treatment should be consistent with the likely nature of the condition." Meaning, someone presenting with symptoms of a CVA, and who are extensively evaluated for this condition, but the condition is found to be ruled out, would ultimately still fall within the high-risk category.
What are some other conditions that you can think of or have seen that may fall within the high-risk category?
In this case, high risk category problems and their definitions are listed.
Acute or chronic illness or injury that poses a threat to life or bodily function: An acute illness with systemic symptoms, an acute complicated injury, or a chronic illness or injury with exacerbation and/or progression or side effects of treatment, that poses a threat to life or bodily function in the near term without treatment.
Chronic illness with severe exacerbation, progression or side effects of treatment: The severe exacerbation or progression of a chronic illness or severe side effects of treatment that have significant risk of morbidity and may require hospital level of care.
Common scenarios in the ED might include: pulmonary embolism, respiratory failure, AMI, small bowel obstruction, GI bleed, severe sepsis, acute renal failure, threat or attempt to harm oneself or others, CVAs, TIAs.
I can definitely see severe exacerbation of heart failure, diabetes and cancer (all chronic illnesses), requiring hospitalization falling into this category.
These are pretty obvious scenarios. However, it is important to remember that in the guidelines it states, "the final Dx for a condition does not, in and of itself, determine the complexity or risk, as extensive evaluation may be required to reach the conclusion that the signs or symptoms do not represent a highly morbid condition." However, it is also imperative to understand is that "the evaluation and/or treatment should be consistent with the likely nature of the condition." Meaning, someone presenting with symptoms of a CVA, and who are extensively evaluated for this condition, but the condition is found to be ruled out, would ultimately still fall within the high-risk category.
What are some other conditions that you can think of or have seen that may fall within the high-risk category?