Orthopedic Coding Alert

Question: When we are coding for evaluation and management (E/M) services, what role does the nature of presenting problem (NOPP) element play in code selection?

Montana Subscriber

Answer: “The NOPP is listed in the description of all E/M codes as an additional component that might influence the providers’ choice of the level of service applicable on the date of the encounter,” explains Melanie Witt, RN, CPC, MA, an independent coding expert based in Guadalupita, New Mexico.

You can determine a patient’s presenting problem type using the following CPT^® guidelines:

• Minimal presenting problems might not require a physician’s presence but do require a service provided under the physician’s supervision.
• Minor or self-limited presenting problems run a definite, prescribed course then fade (i.e., they’re transient); they are not likely to alter the patient’s health permanently and have a good prognosis with management/compliance.
• Low severity presenting problems have a low risk of morbidity without treatment, there is little to no risk of mortality without treatment, and the patient is expected to recover fully without functional impairment.
• Moderate severity presenting problems have a moderate risk of morbidity, uncertain prognosis, or an increased probability of prolonged functional impairment without treatment. There is moderate risk of mortality without treatment.
• High severity presenting problems have an extreme or high risk of morbidity without medical attention or face the probability of severe, prolonged functional impairment without treatment. There is a moderate to high risk of mortality without treatment.

Coding caution: CPT^® guidelines stipulate that the presenting problem can be determined “with or without a diagnosis being established at the time of the encounter.”