Wiki New provider/established patient/new problem

[wynonna]

How are new problems counted for a provider who just started in our practice? She is reviewing notes from our other providers. Patient has glossitis previously diagnosed by another provider within our practice.
Is glossitis a new problem with uncertain diagnosis to our new provider?
thank you

 

[csperoni]

1) For outpatient E/M 2021, whether or not it's new vs established problem is basically irrelevant. Unlike prior to 2021 or for inpatient, there are not separate points for new problem vs established problem.
2) If the glossitis was diagnosed (even if not by this specific provider), it is not an "undiagnosed new problem with uncertain prognosis."
From the AMA 2021 outpatient E/M guidelines:
Undiagnosed new problem with uncertain prognosis: A problem in the differential diagnosis that represents a condition likely to result in a high risk of morbidity without treatment. An example may be a lump in the breast.

Undiagnosed would be even at the end of the visit, the provider does not know the problem. Note it also states the condition is likely to result in a high risk of morbidity without treatment. Other than the example provided by AMA, I would give moderate/severe abdominal pain without a known cause. The patient could have appendicitis, diverticulitis, etc. Whereas mild pain of L 5th toe without a known cause is not nearly as likely to result in a high risk of morbidity without treatment. The patient probably forgot they stubbed their toe, or a new pair of shoes is uncomfortable.

 

[wynonna]

thank you kindly. I find determining problems as self limited, acute, chronic, and moderate risk or high risk morbidity to often be a clinical decision. When in doubt I message the provider.
and thank you for your expertise.