Adult Integrated Case Management Using INTERMED

Adult Integrated Case Management Using INTERMED

Adult Integrated Case Management Using INTERMED

Clinical Notes for:

Lucinda, Robert and Paul

Suggestion: To understand the coding for these chapters, it’s important for you to read through Chapter 7: Adult Integrated Case Management Using INTERMED- Complexity Assessment Grid Methodology and Chapter 8: Child/Youth Integrated Case Management Using INTERMED- Complexity Assessment Grid Methodology.

Lucinda (page 175-195)

Background:

· 37 y/o Mexican American woman

· Overweight

· Diabetic

· Referred by insurance reviewer due to overuse of medical services and after a provider sent a request in to have her gangrenous middle to removed

· Frequent medical procedures used/frequent hospitalizations/ER visits

· Last 12 months: 32 Rx filled from 6 different doctors

· Diabetic specialist (not an endocrinologist)

· Psychiatrists who Rx diazepam

· Surgeon

· # PCP

· Medical issues:

· Type 1 Diabetic since teen years

· 400+ Blood Glucose Levels (BGL)

· Gangrenous middle toe

· Chronic infections (skin and body)

· Ongoing fever off 104

· ALC 9.2 (snapshot of a diabetic’s overall blood sugar level over previous 3 months)

· Vision problems

· High Blood pressure (hypertension)

· Kidney disease

· Back and leg pain related to neuropathy

· Insomnia

Notes:

Focus on her readiness for change (VAS score)

Chart 10 in the supplemental packet is the Care Plan Development, which is also located on page 142, as a completed chart for Lucinda.

The questions (1-3 with follow-up questions) are in response to the Standard Questions. These are also listed in the Supplemental packet, in section E, page 13.

Make sure to review Ellen’s notes because they give you a lot of information and responses to the listed questions. Pay attention to Lucinda’s issues of: limited family/outside support network; family history of diabetes (mom is a diabetic and her own daughter is pre-diabetic and overweight); financial issues (uncertain about her job, has not been to work in last 3 months).

This is the worse 3 years in terms of her ability to control her diabetes- why? What change?

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PCP can’t always see her, so she does see other providers who give her conflicting information.

· She is currently taking 10 different medications

· She checks her blood sugar when she feels bad but isn’t honest about her numbers due to embarrassment

· Misses her insulin because it’s unaffordable for her

· Has had diabetes management training in the past but has forgotten most of the information

· Often feels defeated in her management