Gastroenterology Coding Alert

Question: Is there a specific time limit that distinguishes “acute” from “chronic” conditions?

Georgia Subscriber

Answer: Unfortunately, no. ICD-10 guidelines and other authoritative sources don’t provide a specific time limit that distinguishes the terms. In fact, there is a large degree of variation in the time a disease must be present for something to be referred to as chronic, so a definitive timeframe will depend on who you ask. Look at the following statements to see a range of time used to define “chronic.”

• The Centers for Disease Control and Prevention (CDC) describes chronic diseases as “conditions that last one year or more and require ongoing medical attention or limit activities of daily living or both.”
• CPT^® guidelines for evaluation and management (E/M) codes list a stable, chronic illness as “a problem with an expected duration of at least one year or until the death of the patient.”
• The U.S. National Center for Health Statistics defines chronic disease as one lasting three months or more.
• The American College of Gastroenterology (ACG) does not provide a definition, but does refer to chronic conditions, including chronic liver disease and chronic gastritis, which persist over a long period of time, often several months.

While ICD-10 doesn’t provide a timeframe, Official Guideline Section I.C.6.b.4 says this in reference to chronic pain: “There is no time frame defining when pain becomes chronic pain. The provider’s documentation should be used.”

Bottom line: Whether a condition is defined as acute or chronic comes down to your provider’s judgment. If the documentation lists acute or chronic, then that is how you will determine your code assignment.