There is a debate between the doctors and our department:
An ultrasound was done and the patient has a 5 cm mass near her ovary. The MD is planning surgery to remove the mass, it is not known for certain whether or not the mass is benign or malignant. The MD believes that the mass is an identified risk factor because the mass is potentially cancerous. We believe that at this point, the surgery should not be given credit for high risk surgery with identified risk factors because the mass is not identified as being cancerous at this point.
I could consider this being a risk factor if the provider makes the case for it in the note, but just a mass with the potential of being malignant we do not believe to be an inherent identified risk factor.
Thoughts???? Thank you!