Practice Management Alert

Reader Question:

Don’t Equate ‘Acute’ With ‘New’ for MDM

Published on Thu Nov 16, 2023

Question: I noticed that the Number and Complexity of Problems Addressed column includes “1 stable, acute illness” in the list of examples of low-level medical decision making (MDM) for evaluation and management (E/M) services. Does this mean “acute” and “new” are interchangeable terms?

Minnesota Subscriber

Answer: Acute: “I often see coders assuming that ‘acute’ must equate ‘new,’” explained Jacob Swartzwelder, CPC, CRC, CIC, CEMC, AAPC Approved Instructor, managing director at Compliant Approach Partners LLC in Las Vegas, NV, during his session “E/M Audits for Primary Care” at HEALTHCON Regional 2023 in Washington, D.C.

The condition does not have to be new. In fact, the CPT^®E/M guidelines define an acute, uncomplicated illness or injury as a “recent or new short-term problem with low risk of morbidity for which treatment is considered.” Thus, you can safely interpret “acute” to include follow-up to an acute, uncomplicated injury or illness.

“Just ensure treatment has previously been initiated and the condition is not fully resolved,” Swartzwelder said.

Remember, you’re aligning the problem element with low-overall MDM. “Generally, medically necessary follow-up for a resolved condition will align with straightforward overall MDM,” he said.