Oncology & Hematology Coding Alert
Count Only Conditions Managed During E/M
Question: Our provider is treating a patient for polycythemia and leukocytosis. The patient also has hypertension and diabetes, but another doctor is managing the patient’s care for those conditions. Can we count the hypertension and diabetes under the number and complexity of problems addressed element of office/outpatient evaluation and management (E/M) medical decision making (MDM)? AAPC Forum Participant Answer: The answer to your question lies in the full name of the element you mention: the number and complexity of problems addressed during the encounter (emphasis added). You can only count the hypertension and diabetes as codable diagnoses if (1) your provider is managing the conditions (for example, analyzing tests or managing prescription drugs related to the conditions) at the encounter, or (2) your provider is assessing how the hypertension and diabetes are affecting their treatment of the patient’s polycythemia and leukocytosis at the encounter. If the conditions are not being managed or assessed as described above, then you cannot count the conditions as a part of the number and complexity of problems addressed MDM element. 
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Count Only Conditions Managed During E/M
Question: Our provider is treating a patient for polycythemia and leukocytosis. The patient also has hypertension [...]
