Wiki 2021 E&M Guidelines for new illness/problem in MDM

[wynonna]

Hello there:
What is the difference between "1 acute, uncomplicated illness or injury" for low
and "1 undiagnosed new problem with uncertain prognosis?" for moderate in MDM?
thank you

 

[csperoni]

Per the AMA 2021 guideline
Acute, uncomplicated illness or injury: A recent or new short-term problem with low risk of morbidity
for which treatment is considered. There is little to no risk of mortality with treatment, and full recovery
without functional impairment is expected. A problem that is normally self-limited or minor but is not
resolving consistent with a definite and prescribed course is an acute, uncomplicated illness. Examples
may include cystitis, allergic rhinitis, or a simple sprain.
Undiagnosed new problem with uncertain prognosis: A problem in the differential diagnosis that
represents a condition likely to result in a high risk of morbidity without treatment. An example may be a
lump in the breast.

 

[wynonna]

thank you so much!

 

[carlystur]

Those definitions are in the guidelines section of our CPT books along with other definitions for every other item on the 2021 E/M Coding Grid. Alternatively, you can find the definitions for all the terms listed in this PDF.

 

[wynonna]

thank you kindly. I know the AMA came up with a new grid/audit tool that doesn't differentiate as clearly between OTC and RX management.