Wiki MDM estab or new prob

[kerryann]

Oh boy - here goes: Providers A and B are Family Medicine providers in the same group practice.
Scenario: Provider A see's (regular) established patient for a headache. Two weeks later Provider B see's same patient for headache.
In box A of MDM, is this problem new or established to provider B.
Really interested in hearing from any auditors (and coders) on this. It's a topic that recently became a pretty big discussion. (I shook my head and said DUH...that didn't quite cut it)
It's nowhere to be found on CMS so any references would also be awesome. Thanks in advance.

 

[Chelle-Lynn]

In the Marshfield Clinic’s audit worksheets, a “new problem” is defined as new to the examining physician. “The decision making guidelines were designed to give physicians credit for the complexity of their thought processes. Giving a physician more credit for handling a problem he or she is seeing for the first time, even when that problem has been previously identified or diagnosed, is within the spirit of the guidelines”. (Bart McCann, MD, former Executive Medical Director HCFA)

* Problems are defined relative to the examiner, not the patient.
* Even if the problem was previously known to other physicians or to the patient, it is still considered new to you if you are seeing the patient for the first time.

However, in the arena of providers who work in the same office, same specialty and are often scheduled to see each other patients as a matter of practice for follow up's many offices will set an internal policy to consider the MDM as established, based on this relationship and office set up