Wiki MDM patient not at treatment goal if transferred to another facility?

[wynonna]

Meaning of stable in acute illness?
Note says jaw pain, 90 % recovery, discomfort opening mouth.
Do these symptoms and fact that patient is being transferred to another facility indicate unstable illness?
Or, in other words, patient is not at treatment goal?
thank you

 

[csperoni]

https://www.ama-assn.org/system/files/2019-06/cpt-office-prolonged-svs-code-changes.pdf

I strongly suggest everyone read, re-read, re-read then re-read the AMA 2021 outpatient E/M guide. If you have a question, read it again. I still refer to it regularly and it really does clear up most confusion.

 

[thomas7331]

I second Christine's advice here. Moreover, I'd just add that if the guidelines still don't give you a clear answer, then you're likely looking at a situation where you have to make a judgment call. It's the nature of the coding business, but especially in the area of E&M coding, that there are always new situations and grey areas that aren't covered by a specific written regulation or guideline, and a coder needs to be able to examine the documentation and decide what they think is best. There's not always going to be a right or wrong answer, or a guideline for every situation you encounter.

 

[wynonna]

After rereading and rereading the ama website suggested above, I have come to the conclusion that patient is NOT at treatment goal since he is 90% better, and not 100% better. Also he is not ready for discharge and is still experiencing pain.
Since he is being transferred for further treatment, I feel patient is UNSTABLE if he requires further treatment for this acute problem, even though problem is not chronic and worsening.
If someone feels differently, please let me know.
Thank you as always, to my fellow coders.