I have been struggling with this topic as well. Every time I ask anyone about it even seasoned coders, I don't get a very clear explanation on how to know what falls here. This is all I have been able to find regarding this. My providers love to use this when leveling the visit often times giving a 4 over a 3 when used. There are a few things that stand out to me in the definition. One it has to have high risk of morbidity ( when you have a specific illness or condition) without txt. What is the difference btw acute illness and minor illness? I can not find any clinical examples either.
Acute illness with systemic symptoms: An illness that causes systemic symptoms and has a high risk of morbidity without treatment. For systemic general symptoms, such as fever, body aches, or fatigue in a minor illness that may be treated to alleviate symptoms, shorten the course of illness, or to prevent complications, see the definitions for self-limited or minor problem or acute, uncomplicated illness or injury. Systemic symptoms may not be general but may be single system. Examples may include pyelonephritis, pneumonitis, or colitis.
Examples may include acute myocardial infarction, pulmonary embolus, severe respiratory distress, progressive severe rheumatoid arthritis, psychiatric illness with potential threat to self or others, peritonitis, acute renal failure, or an abrupt change in neurologic status.
Some of my claims are patients that have maybe fever, sore throat, headache and we test for covid. Providers are many times putting these into that category. It would be great to get some coders out here to put some good examples of when this can and should be used.