# Definition of "to examiner" for MDM



## torih@nwurology.com (Jun 21, 2013)

Good Morning,

In box A of MDM, I need clarification on what "to examiner" means. We have had a couple of physicians retire so their patients are now being seen by other physicians in the practice (same specialty). Would these problems be New problem to examiner or est. problem to examiner? My reasoning is that it would be a new problem because the "new" physician hasn't seen the pt before and has to review the pt's history.

Thanks
Tori


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## mhstrauss (Jun 21, 2013)

torih@portlandurology.com said:


> Good Morning,
> 
> In box A of MDM, I need clarification on what "to examiner" means. We have had a couple of physicians retire so their patients are now being seen by other physicians in the practice (same specialty). Would these problems be New problem to examiner or est. problem to examiner? My reasoning is that it would be a new problem because the "new" physician hasn't seen the pt before and has to review the pt's history.
> 
> ...



I agree that this situation does qualify for "new problem to examiner", since this specific provider has never evaluated that particular problem.  Same for NPP's in the same dept. as the MD when the NPP sees a patient/problem for the first time.  I received clarification of this during a webinar presented by our MAC (Novitas) awhile back.

Hope this helps!


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## MikeEnos (Jun 21, 2013)

Yes, these are new problems to the examiner, however the patients are established patients due to the 3-year rule for a patient seen in the same group by the same specialty.  That rule does not matter towards the MDM-A points... new problem to the examiner means it is the first time this provider has seen this patient for this problem.


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## GAcoder (May 13, 2015)

*mdm est problem new provider same specialty*

Where can I get documentation on what you are both saying.  I need to show my supervisor that established problem coming into urgent care to see new provider is new problem for that provider on MDM.  i.e.: Established patient seen for abdominal pain several times in urgent care sees different doctor he's never seen before for abdominal pain.  I count it as new problem, but can't fnd documentation to support that.  help!


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## mhstrauss (May 13, 2015)

GAcoder said:


> Where can I get documentation on what you are both saying.  I need to show my supervisor that established problem coming into urgent care to see new provider is new problem for that provider on MDM.  i.e.: Established patient seen for abdominal pain several times in urgent care sees different doctor he's never seen before for abdominal pain.  I count it as new problem, but can't fnd documentation to support that.  help!




EMUniversity has a brief statement about this here. I don't remember ever coming across this in regulatory guidance though. HTH!

http://emuniversity.com/ProblemPoints.html


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## jdibble (May 13, 2015)

GAcoder said:


> ...i.e.: Established patient seen for abdominal pain several times in urgent care sees different doctor he's never seen before for abdominal pain.  I count it as new problem, but can't fnd documentation to support that.  help!



The physician seeing the patient for the "new problem" must document in the record that this is a new problem for them! It cannot be asumed that this is a new problem to that provider if it is not documented in the patient's chart by the doctor that this is a new problem to them.


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