# Maximum number & points for establised problem



## sathyaraj (Jun 9, 2014)

Hello, 
I have a doubt to count the Number of Diagnoses/ Treatment Options for establised problem to the examining physician, I always used to count 'N' number of points for establised problems it lead morethan 4 points to lead Table A high,but my manager said to count there is a maximum two establised problems in table A. Can anyone explain me about the counting the maximum points in Table A

Thanks,
Sathyaraj CPC,CEMC


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## kallurisivanand (Jun 10, 2014)

*Diagnoses/ Treatment Options for establised problem*

Yes we have to count 2 points for established problem to a physician & count point if any treatment plan


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## CatchTheWind (Jun 10, 2014)

If you are using the 1997 guidelines, you can count a maximum of 3 resolved, stable, or improving established problems, plus 2 inadequately controlled or worsening established problems, plus 2 self-limited or minor problems.


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## sathyaraj (Jun 13, 2014)

Thank you for your reply, is there any 1997 guidelines for MDM


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## CatchTheWind (Jun 13, 2014)

Yes, there are.  They seem to all be in PDF format, so I am not able to copy the URL.  But if you Google CMS E&M 1997 Guidelines, you'll see these in the top three links.


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## sathyaraj (Jun 15, 2014)

I cannot able to find the specific 1997 MDM guidelines in cms, so please kindly share with me the URL apart from this

http://www.cms.gov/Outreach-and-Edu...ork-MLN/MLNProducts/downloads/ReferenceII.pdf

https://www.cms.gov/Outreach-and-Ed.../downloads/eval_mgmt_serv_guide-icn006764.pdf


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## mhstrauss (Jun 16, 2014)

sathyaraj said:


> I cannot able to find the specific 1997 MDM guidelines in cms, so please kindly share with me the URL apart from this
> 
> http://www.cms.gov/Outreach-and-Edu...ork-MLN/MLNProducts/downloads/ReferenceII.pdf
> 
> https://www.cms.gov/Outreach-and-Ed.../downloads/eval_mgmt_serv_guide-icn006764.pdf



Here is the link specifically to the CMS 1997 E/M DG:

http://www.cms.gov/Outreach-and-Edu...N/MLNEdWebGuide/Downloads/97Docguidelines.pdf


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## sathyaraj (Jun 16, 2014)

*Here is the link specifically to the CMS 1997 E/M DG:*

i could'nt able to find the exact guidelines(Page-44) for MDM Table A maximum number of diagnisis in each,there they mentioned the DG of how to select the points from the MDM but not the maximum number of points in Table A, Please guide me the Exact page


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## MnTwins29 (Jun 17, 2014)

It sounds like you are looking for an audit tool that has the table that you are looking for.   If you search any CMS MAC, they will have an audit tool that has the table you are looking for.  I assume you are thinking of the table that says, for example, three points for a new problem, no workup (maximum of 1).


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## mhstrauss (Jun 17, 2014)

MnTwins29 said:


> It sounds like you are looking for an audit tool that has the table that you are looking for.   If you search any CMS MAC, they will have an audit tool that has the table you are looking for.  I assume you are thinking of the table that says, for example, three points for a new problem, no workup (maximum of 1).




No, that specific information is not in the DG's.  Here is a link to the Novitas Audit Tool, the top left box of page 3 shows the max points for each category that has a maximum.

Hope this helps!

http://www.novitas-solutions.com/we...es%2FMedicareJH&_adf.ctrl-state=u19qzr2wt_260


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