Oncology & Hematology Coding Alert

Question: If the patient presents as a new patient to your practice but has history of a past cancer, do you mark as chronic illness in MDM, or can you count as a new diagnosis since they are a new patient to your practice?

AAPC Forum Participant

Answer: You should count this differently depending on the exact circumstances (i.e., How past is past? Are you the physician monitoring the cancer for signs of recurrence? Or is it really just an element in their history?).

Two different extreme examples are:

1. You are a PCP. New patient comes to you and in taking her history, she states she had ovarian cancer 25 years ago treated with surgery, no further treatment needed and no further problems. You advised her to ensure she sees her gyn annually. In this case, you should not count that a new diagnosis.
2. You are a gyn-onc. New patient comes to you and had surgery for stage 4 ovarian cancer 8 months ago, followed by paclitaxel/carbo chemotherapy; BRCA II+. Post treatment PET shows NED. That you should call a new problem if work is performed to address or follow up due to signs, symptoms or the high risk monitoring of the past disease.

Additionally, for 2020, whether the illness is chronic or acute falls into the risk table of MDM. Whether it is a new problem or established problem falls in the issue being treated element of MDM. For 2021 office visits, new problem or established problem no longer matters.

Note: New problem to the examiner applies across providers in groups of the same specialty, similar to new patient definitions. So, if in example 2 above, the original surgeon was another gyn-onc part of the same very large (2400+) health system group of physicians, this would be an established patient with an established problem. (For more information, go to: https://www.aapc.com/blog/48792-mdm-new-problem-to-examiner-or-patient/)