# Stable Chronic illnesses for MDM



## twdevore (Sep 18, 2018)

I've been searching for a list of Stable/Chronic illnesses that I can use in the Medical Decision making when leveling a note. Everywhere I look lists the same 4-5 conditions. 
 HTN, NIDDM, cataract, BPH. These are prefixed with "e.g." on all the audit tools which I take to mean these are simply examples. Does anyone have a reference for all/other conditions that can be counted? Can I used CKD, CHF, etc?

Thanks


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## Pathos (Sep 18, 2018)

Are you asking what makes a condition Chronic and Stable?

If so I have a good reference from MedlinePlus.gov:

"*Acute *conditions are severe and *sudden *in onset. This could describe anything from a broken bone to an asthma attack. A *chronic *condition, by contrast is a *long-developing* syndrome, such as osteoporosis or asthma. Note that osteoporosis, a chronic condition, may cause a broken bone, an acute condition. An acute asthma attack occurs in the midst of the chronic disease of asthma. Acute conditions, such as a first asthma attack, may lead to a chronic syndrome if untreated".

In other words, if a condition is thought to be long-lived then it's probably chronic. Conversely, if the condition is thought to have a short life span, then acute is probably the right status.

In terms of Stable vs. Not-stable (worsening), this really falls on the provider's documentation. Does the provider spell it out for us that the patient is still having a rough time? Does the provider have to change the medication/problem management because of no/little relief by current management? I ask every provider to be explicit as possible in order to remove any doubt of how the patient is doing and progressing/degressing. Helps a ton when we audit and should shield them more in an external audit.

In summary, a condition can both be acute and chronic depending on the situation. The condition could even go from being acute to chronic, as Medline states above. Support your provider to get their documentation to a level which would leave no doubt on the patient's condition and status.


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## twdevore (Sep 18, 2018)

I'm asking what conditions I can count towards the Dx/Management options when leveling a note.


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## Pathos (Sep 18, 2018)

Any conditions the provider is actively managing/treating can be counted towards the Dx/Mx Options part of MDM. I would be very hesitant to rely on a static list, as the status of a condition tends to change during the lifetime of a condition. A problem could start out as *New Problem w/ Additional workup*, then later become *Established Worsening*, and hopefully eventually become *Established Stable/Improving*. 

Also, keep in mind that documentation should be clear on what the provider is actually treating. Supplying a laundry list of diagnoses and not addressing them is not managing the problem. Finally, if the problems treated are not *Medically Necessary*, then you would have a hard time defending your case against an audit.

Hope this helps better!


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## marycrabb (Sep 19, 2018)

*Medicare FAQ*

2. What is "Status of chronic conditions"?

In 1997, the E/M Guidelines enhanced the history of present illness (HPI) section of the 1995 score sheet to include the patient's chronic conditions the practitioner is following or in which an exacerbation may have occurred resulting in the chief complaint and the reason for the patient encounter. The documentation in the patient's medical record must clearly state a status of the chronic condition in order to meet the requirement under the HPI Status of 1, 2, or 3 Chronic Conditions on the 1995 score sheet. An example could be hypertension - stable on Atenolol


Not sure if this is what you are looking for?


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## twdevore (Sep 19, 2018)

I'm looking for conditions that I can use in the Medical Decision Making section in addition to "HTN, NIDDM, BPH". We only use 95 guidelines here. Can I use CHF, ARF or anything else in this section? It seems to me that there should be more Stable Chronic conditions that could be used.


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