Neurology & Pain Management Coding Alert

Question: Is there any difference between a chronic condition and a stable condition, especially as they might pertain to evaluation and management (E/M) leveling?

New Jersey Subscriber

Answer: A stable condition is straightforward problem with an expected duration of at least a year. It’s managed, stable, and predictable, says Terry Fletcher, BS, CPC, CCC, CEMC, CCS, CCS-P, CMC, CMCSC, CMCS, ACS-CA, SCP-CA, owner of Terry Fletcher Consulting Inc. and a consultant, auditor, educator, author, and podcaster at Code Cast, in Laguna Niguel, California. An example might be a patient with hypertension or diabetes whose conditions are being managed in a way that is meeting the clinician’s and patient’s treatment goals.

If a patient is living with a chronic condition that isn’t really changing or fluctuating but the patient is not meeting treatment goals, then under the AMA guidelines for E/M services, their condition wouldn’t be considered stable, Fletcher says.

Providers should document chronic conditions carefully, especially when outlining treatment goals.