# How to Define Nature of Presenting Problem



## lhohler (Jan 11, 2013)

I have heard the Nature of the presenting Problem (NoPP) defined several ways and was wondering how ED coders define NoPP.   In relation to the Tbl of Risk, is the NoPP defined by the patient's presenting symptoms or due you look at the Final Impression to determine which you will use for the NoPP.   Example: patient w/ previous heart condition presents to the ED with chest pain.  After workup (labs, CXR, EKG, etc), the physician state the dx as gastritis and the pt is given GI cocktail and sent home.  If you look at chest pain, the NoPP would probably be High.  If you look at Gastritis, the NoPP would probably be Moderate.
Your thoughts?


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## jimbo1231 (Jan 11, 2013)

*Presenting Problem*

You would look at the reason the patient came to the ED which is Chest Pain. Gastritis is the diagnosis after the physician ruled out cardiac related cause of chest pain. The work up done to R/O for example an M/I would contribute to the MDM.

Jim


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