# Urgent !!!!!!!!!!!!!!!!!!!!!!!! Please help!!!!!!!!!!! MDM TABLE A



## NishaJ (May 6, 2017)

Hi  guys,

      I need an advice as soon as,
     A patient came to Dr. A  (MD)  for  Cold sore, and Prescribed with Rx , Later  he came for Refill to the same practice and examined by  PA for cold sore and make a refill. I just want to how we can count the point for MDM-TABLE A, whether it is New problem or established problem....

      As per the CMS guidelines,  this problem should be considered as  an established to Dr . A, but this is a New problem for  PA, since now only he met this Patient ....

    How we can code this...  I need a  help on this....

Thanks in advance........


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## ellzeycoding (May 6, 2017)

If it's a group practice, the patient was established by the first doctor to the group (which includes the PA).  It's no longer a new patient or a new problem.

It doesn't matter that the PA hadn't seen the patient before.


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## Sarah Ann (May 6, 2017)

As far as the new problem to provider goes; it's based on whether it's an established problem to the patient, not the provider any longer.
_It used to be (on the MDM table) new problem to provider, OR established problem to provider.
_
I think as of this year it's new problem to patient and established problem to patient to choose from.

The 3 year rule applies to whether a patient is new or established.


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## ellzeycoding (May 6, 2017)

Cheryl O. said:


> As far as the new problem to provider goes; it's based on whether it's an established problem to the patient, not the provider any longer.
> _It used to be (on the MDM table) new problem to provider, OR established problem to provider.
> _
> I think as of this year it's new problem to patient and established problem to patient to choose from.
> ...



Do you know where we can see this change?


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## Sarah Ann (May 6, 2017)

*E/M leveling tool*

Go to National Govt. Services-you can sign in as a guest.  
Where is the NGS E&M training tool/scoresheet located on the NGS website?

Answer: Evaluation & Management Documentation Training Tool is located under the Medical Policy & Review tab, then Policy Education Topics > Evaluation and Management > Evaluation & Management Documentation Training Tool.


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## ellzeycoding (May 7, 2017)

Ah, that would explain it.  NGS has done some weird stuff lately, that isn't consistent with national CMS or CPT policy.  But thank you.


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## Sarah Ann (May 7, 2017)

ellzeycoding said:


> Ah, that would explain it.  NGS has done some weird stuff lately, that isn't consistent with national CMS or CPT policy.  But thank you.



They're a MAC~ their policies should be concordant with CMS. Correct?


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## ellzeycoding (May 7, 2017)

Nope.  Policies can vary from MAC to MAC.

For example, some MACs don't recognize modifer 76 on surgical procedures.  Others do.

NGS has come out with some unusual E/M policies lately, found nowhere else.


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## Sarah Ann (May 7, 2017)

Interesting! Thanks.


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## shanamarie (May 10, 2017)

So I found the new training tool that has been updated as of March 2017.  Has anyone found anything stating that this was updated?  I'm just hoping to have an article or something to reference mentioning the update.  Thanks!


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## NishaJ (May 14, 2017)

Thank you guys


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## Sarah Ann (May 29, 2017)

*leveling tool 2017*

This was found on our regional MAC- but no "hey heads up, this is new for 2017" nothing like that.
Look through the thread about NGS though.


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## Kris Cuddy (May 31, 2017)

I'd reconsider counting it as a new problem because unless there's some underlying comorbidity that increases this patient's risk it really should fall into the self-limited minor problem category.


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