# Is problem a new problem or  self-limited problem



## CindyWeems (Feb 25, 2016)

Pt. comes in and is diagnoses with Upper Respiratory Infection x 3 days.  Would this be counted in an audit as a "new problem" worth 3 points or a self-limited problem worth 1 point?   Thanks for helping me out on this.


----------



## KMCFADYEN (Feb 26, 2016)

If this is first patient encounter for infection it is a new problem-3 points with no additional work up (or 4 points with additional work up)


----------



## thomas7331 (Feb 27, 2016)

I think it's very difficult to categorically say what problems are 'self-limited'.  (A physician once told me that ALL problems are self-limited because the patient always either recovers or dies!)  I think the best practice is to give the provider the benefit of the doubt that it's a 'new problem' unless the documentation makes clear that it is not serious and will resolve without treatment.  My experience has been that unless they have a really strong clinical background, if coders/auditors get too deep into deciding that the problems a provider is treating aren't serious, it ends up just causing a lot of friction.  But I do recommend taking a look at the clinical examples in Appendix C of the CPT book as it gives you a good starting point for what types of problems might fall into what level of E&M.


----------



## ValerieBatesHoffCPCCPMA (Mar 13, 2016)

*Someone asked this question before...*

This link has some informative answers from a previous posting about the same question.



https://www.aapc.com/memberarea/forums/32046-medical-decision.html


----------

