Acute uncomplicated illness or injury requiring hospital inpatient or observation level care
As 2021 documentation guidelines are moving into other types and places of service, it’s time to start taking a deep dive! I want to start by looking at some of the implementations that have changed. There were two major new adaptions in the guidelines in Column One specifically to help with inpatient places of service. Two new definitions have been added (this is on page 15 of the 2023 revisions to 2021 documentation guidelines). If you have not downloaded those yet, or maybe you’ve lost your placeholder, you can find those on our dedicated web page for 2021 documentation guidelines on the NAMAS website. The new definition we’re discussing today is acute uncomplicated illness or injury requiring hospital inpatient or observation level care, and it falls under the low level on your MDM chart and there is a revision to the MDM chart (if you look inside your 2023 revisions, you’ll see that the MDM chart has been revised, they’ve just not released a new pretty version yet). We also see a more thorough definition:
“A recent or new short-term problem with low risk of morbidity for which treatment is required. There is little to no risk of mortality with treatment. Full recovery without functional impairment is expected. The treatment required is delivered in a hospital setting.”
OK, that’s easy, very straightforward. However, I want to break this definition down just a little bit more.
“A new short-term problem with low risk of morbidity for which treatment is required.”
So, it’s a short-term problem, and there is low risk of morbidity. Now, let’s stop right there. One of the things that I’m trying to get people to understand is AMA’s definition of “morbidity.” When we think of morbidity, we tend to automatically think of the absolute end-of-life. Listen to the definition of morbidity per the AMA found on page 18:
“It is a state of illness or functional impairment that is expected to be of substantial duration during which function is limited, quality of life is impaired, or there is organ damage that may be transient.”
So, it’s also functional impairment that impacts the quality of life. It’s quality of life, not just end of life. When we read this again, it says it is a recent new short-term problem with low risk for which treatment is considered, there is little to no risk that it’s going to impact the quality of life, without functional impairment expected. This is a very low-risk problem to the patient. The patient is expected to have a full recovery. So that’s why it falls under the low complexity category.
I hope that’s helpful in explaining one of the new definitions according to the AMA revisions, and next time on our next “Take,” we’ll review some of our other changes and revisions for the new 2023 revisions to the 2021 guidelines.
Again, if you have any questions, comments, need some additional training, please don’t reach out to us namas@namas.co You can also take a look at the video on this topic on the NAMAS YouTube channel.
Your next steps:
- Contact NAMAS for information about customized staff and provider training.
- Read more blog posts to stay updated on the 2023 Revisions to the 2021 E&M Guidelines.
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