Wiki Prescription started and a chronic problem not at treatment goal

[wynonna]

Prescription started and one chronic problem which is not at treatment goal. Chronic problem so far has not responded to treatment. The problem is not new and is not worsening for an established patient.
Would this be 99213 or 99214?
thanks

 

[csperoni]

https://www.ama-assn.org/system/files/2019-06/cpt-office-prolonged-svs-code-changes.pdf Emphasis added to the relevant portions
Stable, chronic illness: A problem with an expected duration of at least one year or until the death of the patient. For the purpose of defining chronicity, conditions are treated as chronic whether or not stage or severity changes (eg, uncontrolled diabetes and controlled diabetes are a single chronic condition). “Stable” for the purposes of categorizing MDM is defined by the specific treatment goals for an individual patient. A patient who is not at his or her treatment goal is not stable, even if the condition has not changed and there is no short-term threat to life or function. For example, in a patient with persistently poorly controlled blood pressure for whom better control is a goal is not stable, even if the pressures are not changing and the patient is asymptomatic, the risk of morbidity without treatment is significant. Examples may include well-controlled hypertension, noninsulin- dependent diabetes, cataract, or benign prostatic hyperplasia.
Chronic illness with exacerbation, progression, or side effects of treatment: A chronic illness that is acutely worsening, poorly controlled, or progressing with an intent to control progression and requiring additional supportive care or requiring attention to treatment for side effects but that does not require consideration of hospital level of care.

 

[wynonna]

thank you Christine.