Wiki Diagnoses/management Options

Create Wiki
J

Jlokloski

Networker
Messages
56
Location
Clio, MI
Best answers
0
I need some help understanding when to I have an established problem versus a new problem. I have 11 cardiologist in our group. If one of the cardiologist has seen the patient prior in the office for a diagnosis of chest pain and one year later another one of our doctors sees the patient in the hospital for chest pain is this considered a new problem or an established problem?

Thank you for your help
 
Chest pain is usually an acute event not an established problem, which the fact they haven't seen the patient in a year seems to support. So even if the same provider saw the patient for chest pain then the patient has another episode a year later, it would still be a new problem.

If you have a patient who is actively being treated for chest pain, which one provider sees them say on Monday and their partner follows up for them on Tuesday, this is going to be established from the CMS point of view.

While it is new to the examiner in your scenario, CMS considers providers of the same specialty in the same group as the same person.

Hope this helps,

Laura, CPC, CPMA, CPC-I, CANPC, CEMC
 
auditing prescription drug management

Hi, could someone tell me when E/M code auditing under risk and prescription drug management....does this mean it can be counted IF the physician states, continue current meds, OR can it only be counted if a new prescription is given..??
 
well, a patient can have chest wall pain or angina long term... so it would not necessarily be a new problem....

I have been trained that any time a provider refills meds or orders meds not OTC that this makes MDM moderate.
 
New problem vs. new patient

teresabug said:
it would be an est problem. The provider should be charting if it is stable, worse or improved.
Click to expand...

In calculating points in Table A - number of diagnoses or treatment options, it would be considered a "new problem" to the doctor from the same practice who is seeing the patient for the first time for that diagnosis. When considering which code set to use - new or established, you would use established since the patient had been seen previously within 3 years by another doctor with the same specialty in the same practice.

It can be confusing - but there is a difference between new patient and new problem.

Hope that helps! :)
 
swelch said:
Hi, could someone tell me when E/M code auditing under risk and prescription drug management....does this mean it can be counted IF the physician states, continue current meds, OR can it only be counted if a new prescription is given..??
Click to expand...

This could depend on your MAC as to how much "involvement" the doctor needs to document to count RX management for a moderate risk. Novitas has stated to count it if the doctor is making the decision to refill meds or prescribe. I have worked for a company under another MAC and we were instructed that the physician needs to actively be changing the meds for it to count.

You might want to check with your MAC to see what they consider RX management.
 
You must log in or register to reply here.
Top