# Help with ER E/M worksheet



## jfrankel (Oct 21, 2009)

Hey there fellow coders, I am having trouble figuring out the diagnosis and treatment options for MDM on the E/M worksheet.  I am working strictly on ER claims and need to know if a patient comes into the ER, no matter what the issue is, is that automatically given 3 points for "New Problem (to provider, no add'l workup)" for this section?  In other words, does this mean that the lowest number of points for a patient coming into the ER for section A of the E/M worksheet is 3 pioints, and then 4 points if there's add'l workup???  Any help on this would be really appreciated!!!


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## FTessaBartels (Oct 21, 2009)

*Self limited problems*

Most of the time you are right... but Not necessarily.  

What if the patient comes in with a bee sting ... no allergic reaction, no treatment really. It will get better on its own.  I would call that a self-limited or minor problem. 

Hope that helps.

F Tessa Bartels, CPC, CEMC


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## jfrankel (Oct 21, 2009)

*thanks Tessa*

Thanks, I was also leaning that way and just wanted to make sure.  I am still a little worried that even though it is just a bee sting or something else self limited that it wouldn't be considered a "new problem" to that examiner which would give it that higher level... don't want this to come back and bite me in the end!!!


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## CULINTZ (Sep 25, 2012)

If the physician prescribes a medication for cat scratches without signs of infection or dental infection or any similar scenario where the presenting problem might be considered to be self limiting or minor, would you upgrade the condition to new problem based on a prescription being provided?  Thanks for any input.


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## buuvaneisswaran (Sep 25, 2012)

*Bhuvanesh*

HPI & EXAM-Detailed.

If the presenting problem is NEW to physician(ie.Dysuria) and the patient is Established to the Group.Have ordered urine analysis and found out UTI(Female).The physician prescribed RX too.I am said to go for Level Four E/M.But in Risk of Complications and/or Morbidity or Mortality, the level of Risk in presenting problem in accordance to the patient is going to LOW and Management option is Moderate.When it comes in 2/3 then it would be LOW.I am confused without clear guidance.Any suggestions over this would be appreciated.Thanks


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## fowens (Sep 26, 2012)

CULINTZ said:


> If the physician prescribes a medication for cat scratches without signs of infection or dental infection or any similar scenario where the presenting problem might be considered to be self limiting or minor, would you upgrade the condition to new problem based on a prescription being provided?  Thanks for any input.



You would always consider the problem "new to examiner" on your _diagnoses management options._ The medication is in the _risk_ area of decision making so it will not affect the status of the diagnosis.  He's so far got 1 of 3 as moderate.

On the table of risk you would leave the presenting problem as minor which is low, but when you give med mgmt for a Rx this will upgrade the the risk for this visit to moderate.  

However, since there is no sign of infection; the problem is minor and my thinking is you should leave the table of risk at LOW because of the presenting problem. Medical necessity overrides the volume of documentation and unless the Dr. documents why prescribing a med complicates this issue he should code a 99213. 

Some coders may disagree and I hope to hear their side of it


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