# New E/M Guidelines- Chronic Conditions?



## jessica.belant@aspirus.org (Feb 3, 2021)

Hello-

Wondering if anyone can provide info/insight to help characterize the following conditions as acute or chronic for the sake of determining # of problems according to new E/M Guidelines.

The conditions/examples are:

Pernio (chilblains) – ? flares in very cold temps, clears up on it’s own within 1-3 weeks, but may reoccur.
Chronic actinic damage – ? Sun damage, AK treated as needed. Sun screen less exposure to sunlight is suggested.
Tinea versicolor - ? common fungal infection, creams/lotions, may last for weeks to months.
Capillaritis - ? harmless skin condition also known as pigmented purpura
Urticaria – ? resolves with drug therapy, find offending allergen and avoid it.
stasis dermatitis-
actinic keratosis- treated as needed 

Help would be greatly appreciated.

Thank you.


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## csperoni (Feb 3, 2021)

There are some problems which could be acute for 1 patient, but chronic for another.  There's an AMA guide which gives clarification.  Specifically, chronic is expected to last at least a year.  


			https://www.ama-assn.org/system/files/2019-06/cpt-office-prolonged-svs-code-changes.pdf
		


_Stable, chronic illness:_ A problem with an expected duration of at least a year or until the death of the patient. For the purpose of defining chronicity, conditions are treated as chronic whether or not stage or severity changes (eg, uncontrolled diabetes and controlled diabetes are a single chronic condition). ‘Stable’ for the purposes of categorizing medical decision making is defined by the specific treatment goals for an individual patient. A patient that is not at their treatment goal is not stable, even if the condition has not changed and there is no short-term threat to life or function. For example, a patient with persistently poorly controlled blood pressure for whom better control is a goal is not stable, even if the pressures are not changing and the patient is asymptomatic. The risk of morbidity without treatment is significant. Examples may include well-controlled hypertension, non-insulin dependent diabetes, cataract, or benign prostatic hyperplasia.
_Acute, uncomplicated illness or injury:_ A recent or new short-term problem with low risk of morbidity for which treatment is considered. There is little to no risk of mortality with treatment, and full recovery without functional impairment is expected. A problem that is normally self-limited or minor, but is not resolving consistent with a definite and prescribed course is an acute uncomplicated illness. Examples may include cystitis, allergic rhinitis, or a simple sprain.
_Chronic illness with exacerbation, progression,or side effects of treatment: _A chronic illness thatis acutely worsening, poorly controlled or progressing with an intent to control progression and requiring additional supportive care or requiring attention to treatment for side effects, but that does not require consideration of hospital level of care.
_Acute illness with systemic symptoms:_ An illness that causes systemic symptoms and has a high risk of morbidity without treatment. For systemic general symptoms such as fever, body aches or fatigue in a minor illness that may be treated to alleviate symptoms, shorten the course of illness or to prevent complications, see the definitions for ‘self-limited or minor’or ‘acute, uncomplicated.’ Systemic symptoms may not be general, but may be single system. Examples may include pyelonephritis, pneumonitis, or colitis.


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## jessica.belant@aspirus.org (Feb 4, 2021)

Thanks for your response. I have the AMA definitions.


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## DanaCathleen (Feb 4, 2021)

jessica.belant@aspirus.org said:


> Hello-
> 
> Wondering if anyone can provide info/insight to help characterize the following conditions as acute or chronic for the sake of determining # of problems according to new E/M Guidelines.
> 
> ...


Hello Jessica

With the new e/m guidelines leaning on time and MDM, are you talking about the number and complexity; is that right?  Would table 1 on page 12 in the CPT help?  The examples listed seem to be all of 1 body system/area and nothing extensive or moderate per say.  The current medication and hopefully if the provider describes the stage/issues or asked for a consultant may help.  Table 2 pg. 16 is also a good layout and watch your time.   Hope you already have your answer.  Christine did good on the definitions but unfortunately provider documentation doesn't always give us what we need.  From your examples, seems self limited to me, no underlying stuff.


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