The correct level of overall medical decision making is High.
Read the following medical decision making documentation, then answer the following questions.
Impression: 29-year-old woman well known to this physician returns to the clinic with possible extraesophageal manifestation of GERD.
Plan: Chest X-ray ordered to rule out lung congestion or esophageal mass. Upon independent review of X-ray, consider prescription for proton pump inhibitor therapy and change of lifestyle to reduce stress and improve digestion, including eating five small meals throughout day and no food or drink more than 3 hours before bedtime.
Follow up in one week.
Indicate whether this statement is true or false.
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Q. 2) The correct level for the amount and/or complexity of data to be reviewed is Straightforward as identified by ordering diagnostic data
Read the following medical decision making documentation, then answer the following questions.
Impression: 29-year-old woman well known to this physician returns to the clinic with possible extraesophageal manifestation of GERD.
Plan: Chest X-ray ordered to rule out lung congestion or esophageal mass. Upon independent review of X-ray, consider prescription for proton pump inhibitor therapy and change of lifestyle to reduce stress and improve digestion, including eating five small meals throughout day and no food or drink more than 3 hours before bedtime.
Follow up in one week.
Indicate whether this statement is true or false.
(
Q. 3) The physician documents a new presenting problem with workup, orders a CBC and a urinalysis, and the patient receives a prescription for antibiotics for a urinary tract infection. What is the overall level of medical decision making?
A. Straightforward
B. Low
C. Moderate
D. High
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Q. 4) The correct level for the number of diagnosis and/or management options is Moderate as identified by new presenting problem without work up
Read the following medical decision making documentation, then answer the following questions.
Impression: 29-year-old woman well known to this physician returns to the clinic with possible extraesophageal manifestation of GERD.
Plan: Chest X-ray ordered to rule out lung congestion or esophageal mass. Upon independent review of X-ray, consider prescription for proton pump inhibitor therapy and change of lifestyle to reduce stress and improve digestion, including eating five small meals throughout day and no food or drink more than 3 hours before bedtime.
Follow up in one week.
Indicate whether this statement is true or false.
(
Q. 5) The physician documents a limited number of diagnoses and/or management options, a limited amount and/or complexity of data to be reviewed, and a moderate risk of complications, comorbidities and/or mortality. What is the overall level of medical decision making?
A. Straightforward
B. Low
C. Moderate
D. High
(
Q. 6) The overall level of medical decision making is determined by the lowest of the three elements number of diagnosis(es) and/or management options, amount and/or complexity of data to be reviewed, and risk of complications, comorbidity, or mortality.
Read the following medical decision making documentation, then answer the following questions.
Impression: 29-year-old woman well known to this physician returns to the clinic with possible extraesophageal manifestation of GERD.
Plan: Chest X-ray ordered to rule out lung congestion or esophageal mass. Upon independent review of X-ray, consider prescription for proton pump inhibitor therapy and change of lifestyle to reduce stress and improve digestion, including eating five small meals throughout day and no food or drink more than 3 hours before bedtime.
Follow up in one week.
Indicate whether this statement is true or false.
(
Q. 7) The high overall level of medical decision making requires which of the following?
A. reflects more complicated coordination on the part of the physician performing the E/M service but does not pose an excessive risk to the patient
B. reflects a relatively uncomplicated process of medical decision making
C. reflects a very intricate process of difficult or extreme decisions, difficult coordination of diagnostic tests or results, complex diagnosis or diagnoses, or convoluted management options
D. reflects a more complicated combination of medical decision-making elements but does not warrant a significant or substantial level of medical decision making
(
Q. 8) The physician sees a seven-year-old patient for a first visit. Patient had a wood sliver in his right hand that is now swollen, tender, and red. Also, just before arriving at the clinic, the patient also suffered a bee sting on his left arm that resulted in mild swelling. History reveals the patient has had no history of severe reaction to bee stings. No identified signs of anaphylaxis from the bee sting. Physical examination of the patient's right hand identifies possible infection of sliver wound site; the physician requests the patient's previous medical records from his former clinic to identify the status of the patient's tetanus immunization status. Physician recommends Epsom salt baths twice daily for the infected right hand and issues a prescription for antibiotics in the event the baths do not help improve the infection. What is the overall level of medical decision making?
A. Straightforward
B. Low
C. Moderate
D. High
(
Q. 9) A patient with well-controlled noninsulin dependent diabetes mellitus visits her regular physician for severe, recurring headaches she has been experiencing for the past month. The physician collects history and learns that the patient has been under tremendous stress at work for the past six weeks. The physician orders blood tests and an EEG because the physician is concerned about the severity of these headaches. What is the overall level of medical decision making?
A. Straightforward
B. Low
C. Moderate
D. High
(
Q. 10) Please complete the following sentence, The overall medical decision making is selected by:
A. the lowest of the three elements, number of diagnosis(es) and/or management options, amount and/or complexity of data, risk of complications, comorbidity, or mortality.
B. the highest of the three of the elements, number of diagnosis(es) and/or management options, amount and/or complexity of data, risk of complications, comorbidity, or mortality.
C. two of the three elements of medical decision making - number of diagnosis(es) and/or management options, amount and/or complexity of data, risk of complications, comorbidity, or mortality - must be met or exceeded.
D. the level of the risk of complications, comorbidity, or mortality determines the overall medical decision making.
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