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AmandaW

AmandaW

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In the ER, would every presenting diagnosis at least be 3 points?
What if it is a "minor or self-limiting" problem but new problem to the Dr?
 
Thank you for your reply. Maybe I'm overthinking it, but why not 3 or 4 depending on workup or no workup in the 'Number of diagnoses or treatment options' for 'New problem to examiner'?
 
This is the same question I am having from a physician in my practice. What is the true definition of a NEW problem.

If patient comes in new to clinic and is complaining of a UTI and doctor prescribes medication and review urine results. How does this qualify for a self-limited decision making?
 
MDM is composed of three parts: problem points ("number of diagnosis or management options"), data points ("amount and/or complexity of data to be reviewed"), and risk level ("risk of complications and/or morbidity or mortality"). You only need two of these to get your level. So you can get a high level without high problem points if you've got enough data points and risk.
 
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Yep. Understand that. Sometimes I can't get it from those places so I was asking about the number of dx or treatment options part.
 
Hello,

I code & bill for physicians who bill professional but see pts in hospital.

I too was confused about this, as my providers could see the pts several times a year under several different admissions. I asked an auditor who was giving an E/M presentation at aapc chapter meeting.

She stated that at every new admit the problems would be considered new to provider even if they had treated that problem under a previous admission.

Not 100% if this would apply to ER but thought I would share.
 
Thank you Midnightsun!

CatchTheWind, Right. Those are the problem points. And you only need two out of the three to get your MDM. Sometimes the Amount and/or Complexity of data reviewed is not very high-sometimes can only get 2 points from there so I have to look at the other two routes when looking into if I can bill a moderate level.
That's where my question came into play. 1 point verses 3 is a major difference. A 'self-limiting' or 'minor' problem CAN be a 'New' problem to examiner. So my question was which way is correct to look at it?

Self-limiting/minor problem - 1 point......OR.......
New problem to examiner - 3 points

???
 
In general, if it will go away on its own, or needs just "reassurance" rather than treatment, then it would be self-limited or minor. Otherwise, new.
 
Thank you. That's a very good way to look at it. I will be using the 'New to examiner' with caution with those minor-ish diagnoses.
 
nomerz, have you ever been audited? If so, it came out ok?

I'm new to ER but I've been doing hospitalists coding for awhile now. In hospitalists coding I didn't have to worry about that so much as they usually have numerous issues going on.
 
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